Dynamic Dialogue with Danny Matranga - 154 - Dr. Kyle Gillett: Hormones, Birth Control, PCOS, Menopause + More

Episode Date: January 17, 2022

Dr. Kyle Gillett is the Medical Director and Head of Treatment \ at Marek Health - today we discuss a variety of hormones, physiology, pathologies, and more!-FOLLOW DR. GILLETT HERE!-Thanks For Listening!SUPPORT THE SHOW:There is NOTHING more valuable to a podcast than leaving a written review and 5-Star Rating. Please consider taking 1-2 minutes to do that HERE.You can also leave a review on SPOTIFY!OUR PARTNERS:Legion Supplements (protein, creatine, + more!), Shop HERE!Get Your FREE LMNT Electrolytes HERE! Care for YOUR Gut, Heart and Skin with SEED Symbiotic HERE!RESOURCES/COACHING:I am all about education and that is not limited to this podcast! Feel free to grab a FREE guide (Nutrition, Training, Macros, Etc!) HERE! Interested in Working With Coach Danny and His One-On-One Coaching Team? Click HERE!Want Coach Danny to Fix Your S*** (training, nutrition, lifestyle, etc) fill the form HERE for a chance to have your current approach reviewed live on the show. Want To Have YOUR Question Answered On an Upcoming Episode of DYNAMIC DIALOGUE? You Can Submit It HERE!Want to Support The Podcast AND Get in Better Shape? Grab a Program HERE!----SOCIAL LINKS:Sign up for the trainer mentorship HEREFollow Coach Danny on INSTAGRAMFollow Coach Danny on TwitterFollow Coach Danny on FacebookGet More In-Depth Articles Written By Yours’ Truly HERE!Support the Show.

Welcome, everybody, to another episode of the Dynamic Dialogue podcast. As always, I am your host, Danny Matrenga, and in today's episode, I'm joined by Dr. Kyle Gillette. Dr. Gillette is a medical doctor, and we will be discussing some of the nuances around hormonal interplay, physiology, and how hormones influence things like our wellness, our fertility, our body composition, our performance, debunking some myths, as well as going quite into the weeds on things like women's physiology, birth control, PCOS, and menopause. This is a conversation I've been looking to have for quite some time. So please sit back and enjoy today's discussion with Dr. Kyle Gillette. Dr. Gillette, how are you doing

today? I'm doing well. Thanks for having me on. It's a pleasure. Absolutely. So I have for a long time been looking to have somebody on that can discuss some of the nuances of how hormones play a role in our physiology with regards to body composition, with regards to performance. And there are a lot of people in the fitness space who I think speak out of turn, or they're not necessarily operating in their scope of practice when they give hormonal information or they create hormone-specific content. And I don't think all of those people are doing so in a nefarious way, but there's a lot of interplay here. There's a lot of nuance and having somebody like yourself, who's a medical doctor on the podcast, I think will really,

really bring us to a good place. We can have a good discussion about that. But just so my audience can get to know you, tell them a little bit about yourself, your background, what got you into medicine and why you're so passionate about preventative medicine, not just the kind of medicine and the kind of treatment we see so commonly in Western medical treatment? Absolutely. So I'm Dr. Kyle Gillette. I am a medical doctor. I am based out of Kansas City.

And in general, other than advocating for true preventative medicine, I advocate for a balanced approach. So supply and demand is the same in every field. for true preventative medicine, I advocate for a balanced approach. So, um, you know, supply and demand is the same in every field, whether it's for your health, um, whether it's cosmetic health, whether it's no tropic health, you know, cognitive health, um, whatever it may be athletic performance, body composition, and, uh, people will find a way to meet the demand. And there is a high demand for people talking about and even giving advice about hormones and body composition. So a lot of people tell me that they've gone to their previous doctor and asked about hormone this, and they've asked about them, they're not feeling great. Do they need this

checked? Do they need X checked? Do they need Y checked? And a lot of people are fairly dismissive because there's not really a standard of practice. So a lot of physicians practice, well, most physicians should practice evidence-based medicine, but a lot of them also go by expert recommendations and different algorithms. And when you're talking about someone that wants to have something other than just preventing pathology, so they want to live optimally and not just prevent a disease, then it becomes a little bit more tricky. And that's where an individualized approach comes in. Yeah, I think that's huge. And this is something that I've experienced quite a bit just with my own interaction with my insurance company or my medical provider, which is if you are unwell or if you are sick, you'll

generally get better care and more respect than if you're somebody who maybe is looking to optimize or take their health into their own hands. And I think running labs or getting labs done and wanting to understand where you're at hormonally is really, really cool. And I think running labs or getting labs done and wanting to understand where you're at hormonally is really, really cool. And I think it's something that is indicative of a population that is more conscientious and aware of their health. But it's also a lot to consider, a lot to think about. If somebody is looking to kind of take control of their health and they want to get that

real physiological insight that comes from looking at labs is this something that they can do easily with their physician with their insurance plan or do you find that it's generally easier for them to go outside of the network maybe go direct concierge there's a lot of different ways what's the fastest and most efficient way and then maybe we can even talk about what some labs might be worth looking at for like males and females who want to optimize health performance, longevity, et cetera. In general, it is easiest to get labs done or get genetic testing done outside of your health insurance. There are exceptions, of course, but usually your health insurance, you know, think of a true preventative medicine. They're probably not going to want to cover your

23andMe or your ancestry.com genetic test. They're probably not going to want to, you know, cover your homocysteine level. So it's usually easier and depending on where you go. So the, I guess the health industry or the medical advice industry is both a good and a service. So there's a lot of places where you can get the good. And then there's also a lot of places where you can get the service, but not ironically or unironically, not many places where you can get both the good and the service. So that's why a lot of people find concierge doctors. And to be clear, even if you're just talking about family physicians or primary

care providers, there is thousands of excellent, there's lots and lots of excellent primary care providers and family doctors. And I've interacted with them and also heard patients talk about their beloved provider. Just not many of them are talking about things like this publicly. Gotcha. And I think that's really fair because it is kind of newer and it's growing. But there is a large section, I think, of the population that is motivated by living better, performing better. And as we become simultaneously more and less scientifically literate if that's possible but

it really feels like some people are more scientifically literate they're more aware they know what they want to focus on i know a lot of people who come to me and go i want to get labs done in fact when i posted about my most recent lab panel i got so many people asking me what lab should i run what should i look at and it's it's great because it's like look i don't know what labs you should run because I don't know what's going on. But if we're talking about, let's say, relatively active adults, we'll start with females and we can talk about males, but relatively active adults who are looking to optimize performance and body composition, do you have a recommendation as for kind of a panel or just a couple of markers, five, three, four, five markers that you think are worth looking at for these populations? Yeah, so an easy set of labs that you could arguably say this could potentially optimize the health in some way of almost everyone.

You're thinking about what your regular doctor gets first. Yeah. You know, you're thinking about what your regular doctor gets first. It's probably a CBC, a complete blood count, a complete metabolic panel, and maybe a TSH, T3, T4, or free T3, free T4, probably a lipid panel as well. And given the recent evidence in JAMA cardiology, probably an APOB if that LDL is above 130, maybe an APOB right off the bat, potentially an LPA. Maybe not if you don't have the genes for it and you've already gotten genetic testing. So that's kind of an easy way to start. And then adding on, assuming that this individual wants to dig a little bit more deep, testing an estradi, and making sure that it's, you know, an accurate assay, um, testing a sensitive assay. So estradiol is kind of like

the most active form of estrogen, the second type of estrogen. And it's important in both men and women for prevention of cardiovascular disease. You don't want it too low. And most people are familiar with what happens when estrogen goes too high. Just think of pregnancy and breastfeeding. So, well, not too high in those cases, but in other cases, right? Testosterone is important in both men and women, including a free testosterone at times, dihydrocystosterone more so in males than females. Then a sex hormone binding globulin, particularly in males and females on HRT, which kind of includes oral contraceptive pills, kind of a type of HRT. So very important for women on COCPs as well, or combination oral contraceptive pills.

That's great. And let's unpack that a little bit, because you said something that I think is interesting. And that is, so often you'll hear people communicate, especially males, estrogen is bad. I do not want any estrogen because for many men, not just men who are using testosterone replacement therapy, or maybe they're dabbling in the dark side of, let's call it self-administered testosterone replacement therapy. And you can get some aromatization, which for those of you listening is just the conversion of testosterone into estrogen. And if that goes haywire and you end up with too much estrogen, that can be problematic. And so from that, many men parrot the ideology that estrogen is bad. And conversely, you'll hear something very similar from women,

which is the notion that testosterone is inherently bad for females. I'd love to unpack that a little bit. What are some of the myths around estrogen in men? Can it be beneficial in any way? And testosterone in women, and can it be beneficial in any way? in any way and testosterone in women and can it be beneficial in any way? Yeah. So, uh, a lot of times here's, here's three kind of, uh, truth bombs, I guess. Uh, one is that the higher the estrogen in the male without symptoms, you know, including like any symptom, but as long as you don't have any symptoms or signs of hyperestrogenism, the higher, the better. Secondarily, the lower your IGF-1 in men and women without symptoms, the better. And then tertiary is in men, the higher your SHBG in men, the better.

So I'll kind of like dive into those. g and men the better so i'll kind of like dive into those women it's it's hard to say like the higher the testosterone the better within and then maybe so someone would feel phenomenal with uh you know uh male levels yeah you know within the normal reference range for men which is several times several orders of magnitude or even like um, three, four standard deviations from the mean of normal female testosterone. That's just where a lot of women feel good. Um, the main problem with that is that a lot of times it's almost kind of like, uh, a very like light version of a gender transition kind of, because a lot of them do have virilization. They feel so fantastic when they're having the slight deepening of the voice or a slight hirsutism or things like that,

then they don't really notice it. Yeah. So, um, yeah, as far as the estrogen in men, it does theoretically decrease your risk of dementia. So men with hypogonadism, low testosterone, and also low estrogen have higher rates of dementia. Also men with hypogonadism, low testosterone, and also low estrogen have higher rates of dementia. Also men who are obese and then lose weight as they enter the geriatric epidemiological age group, I guess, like as they enter the older age group and they're losing weight, they're losing weight. Those men also tend to have very low estrogen and they're also at risk of dementia. And then it also is well known if you're deficient in estrogen and you have increased plaque buildup in the arteries of the

heart and the brain and the rest of your system as well. So estrogen in men is actually cardioprotective. Yeah. In fact, in women that have premature ovarian insufficiency, POI, early menopause, if you will, that is one of the main reasons why women's HRT is usually assessed to be more beneficial than harmful is because of the risk of early cardiovascular disease in those individuals. Wow. And so with circling back to women, one part of the female physiology I'm aware of where we do see an increase in testosterone is actually around ovulation. And I've heard multiple people take a stab at why that is. I have a reason that really makes a lot of sense to me, but for women who are active, or let's say that maybe they're on a contraception, a form of contraception or not, but they want to perform really well. What are some things they should know about testosterone and how it interacts with the female physiology? Is it, I know when we talk about PCOS, if we get to that, we'll talk quite a bit about it, but

what are some baseline things women should know about how testosterone works in their body? Absolutely. So yeah, testosterone does have a lot of benefits for women. Libido is one of them. Keep in mind that free testosterone and total testosterone matter both in men and women. So when testosterone is bound to any binding protein, shbg it does theoretically help it cross cell membranes earlier because of its lipophilicity basically it's it just it can

cross cell membranes easier the blood brain barrier is a type of a cell membrane so it definitely matters it also helps having a high bounce, it helps decrease metabolism of testosterone. So a lot of people with very low SHBGs, like individuals on SARMs or DHT derivatives, they metabolize their testosterone very quickly or women with PCOS or just in general individuals with hyperinsulinemia have low SHBGs. So SHBG does bind estrogen. So it helps you have a nice relatively more stable cycle other than um you know precipitous peaks and troughs which puts you at risk of things like premenstrual dysphoric disorders like pmd um you know in general feeling horrible before your menstrual period so shbg does bind both estrogens and androgens like testosterone.

SHBG is going to be likely, and this depends on your type of synthetic progestin and also your type of synthetic estrogen in your oral contraceptive or any like hormone that you're on. Usually it's going to increase very, very high. Okay. So when you begin taking, let's call it a normal, fairly typically prescribed form of contraception, this will elicit a spike in sex hormone binding globulin. Yeah. For example, ethanol estradiol levonorgestrel is probably one of the most common generic, I suppose. What's the non-generic name for that? Or is there a manufacturer that people might be familiar with? I think that's generic in general. Orthotricicline might have those two same synthetic estrogen and synthetic progestins.

Probably the most common one would be the ethanol estradiol, even orgestral. Don't hold me to it being orthotricicline, but I believe that's it. Anyway, very common to have SHBGs well over 100, uh, often even over 200 and also very common to have undetectable free testosterone levels. Is that because sex hormone binding globulin is so high and the affinity for testosterone is so great that it's basically vacuuming up all the free testosterone. So you might show zero on a lab. Correct.

Gotcha. So in my opinion, that's super important for women to keep in mind. Obviously, there's things like boron or DHEA, which you can talk to your healthcare provider about if you're a good candidate to lower your SHBG from those means or switching over to other things that maybe they don't have as synthetic estrogen, etc cetera. But, um, yeah, those are some of the important things to keep in mind about androgens. Androgens are very important. The other thing that some women don't think about,

but a lot of men do is that women have aromatase enzyme as well. And depending on your like, you know, caloric intake, your caloric deficit versus surplus, your body fat percentage, even your genetics, your aromatase can be very active or relatively inactive. So even if you produce a decent amount of testosterone from both your adrenal glands and your theca cells in the ovaries, a lot of it might be aromatizing anyway. Gotcha. So you might not end up with as much as you think, depending on the form of contraception you're taking or depending on some of these genetic variations that take place from

woman to woman, sticking with the theme of contraception. A lot of my audience is fairly active physically and probably active sexually. So some form of contraception makes sense for them. And there's multiple different forms, but talking specifically here about oral forms of contraception, maybe injectable forms of contraception. I know there are pellet forms that are kind of put into the body and they slowly dissolve into birth control. And then IUDs, which there are hormonal forms of IUDs and non-hormonal forms of IUD, which I think are made from copper. And I've heard some old wives tales, I don't know if it's true or not, as to how they figured out copper worked. But of these different types, maybe let's unpack them a little bit. Are some going to more aggressively affect things like body composition, have a greater impact? Because so many women will communicate that hormonal birth control really altered their body composition. And then are some of these options perhaps better for you if you want the benefits of contraception with as few performance and body composition impacts as

possible? Yeah. So this is a topic that I truly love. So thanks for bringing it up. Before we talk about it, I do want to mention that I love how there's this huge movement of naturalism. So, you know, avoiding endocrine disruptors, avoiding like altering your hormones, especially with synthetic things. And I love that there's like, there's like a solid amount of good naturopathic doctors and chiropractors that practice functional medicine, et cetera. But, um, there's, again, there's got to always be balanced. So as you mentioned, contraception in general is likely one of the things that really helped society get to where it is today, especially as our neonatal mortality rates dropped. So it is a profound, amazing public health benefit.

And that's why there's all these different conspiracies about, because it becomes political or cultural at some point, not controlling the population, but giving the people the ability or freedom to choose how and when to conceive can completely change someone's life. So whenever you're talking about a risk of a different form of contraception, you have to keep in mind that one of the biggest risks is that it doesn't work. And for some people just having the most efficacious form of contraception, which by the way, is the implant, the next one on which replaced the implant on it's even more efficacious than a tubal ligation than getting the tubes tied. So for some people that, you know, uh, it would just essentially be, um, devastating to conceive at that point. That's a pretty good option. It's something we don't talk about often, which is that having a child and beginning or starting

a family isn't in the, you know, not everybody's positioned optimally for that. And that in the modern world, we have the luxury of being able to choose and it really has propelled society forward. There's, there's a lot of benefits to having these things. So I love that you touch on that. Yeah. So to talk about some other options, uh, you know, there's combined oral contraceptives that have, uh, you know, estrogens and progestogens in them. There's non-combined ones, which is basically mini pill or micronor, which is one that you have to take very consistently. And there's a new one called slend as well, which is derived from spironolactone actually. Some synthetic progestins are derived from a 19-nor androgen type ring, almost like nandrolone. But anyway, those are

kind of some of the oral contraceptive options. You touched on the IUDs. So there's hormonal ones. There's Mirena's for women who have had children before or that haven't. And then specifically for noliparous women, there's Kylena's and Skyla's. So those are hormonal IUDuds and they're quite efficacious but typically not uh as effective as the implant and then uh there's also a paraguard which is usually good for about 10 years the other ones are usually good for five years and that's the copper one that people know of um you know the the ancient copper i guess got it or the ancient norse goddess i think it's the norse goddess of

health was like known for copper because copper has all these healing properties but you know copper is super important for iron utilization as well but it has many different mechanisms of action so that one's um somewhat um controversial because there is a chance that you could kind of like conceive on top of it and there's also a chance um kind of like uh is a chance that you could kind of like conceive on top of it. And there's also a chance, um, kind of like, uh, ironically a chance that, uh, although it's antibacterial at the same time, you have a higher chance of inflammation or pelvic inflammatory disease when you use it. Um, so it can potentially like even lead to infertility if you have really bad pelvic inflammatory disease. So it's a really, you know, obviously it's a complicated topic and talking with a healthcare provider that manages contraception is extremely important for it. I'm also particularly interested in men's contraception. My favorite, which I do from time

to time, but not super often is vasectomies. And then there's also a couple different options. There's an implant, which is kind of like really weak anabolic steroids that they're doing clinical trials on. So obviously a lot of men are interested in that one, right? Yeah. Fortunately or unfortunately, I doubt that they will choose one that has any like clinically significant benefit for body composition. Maybe they should, that would really work.

And then there's also an implant for men that is being talked about as well. So quite a few. Oh, and also there's essentially a gel, vessel gel. I think they're doing trials in India of that one where you put in a polymer and then you inject something, a depolymerizing agent when you want to reverse it. So there's a whole host of potential options for men in the future. So hopefully the technology for that continues to progress quickly. the average age at which a woman starts hormonal contraception in this country, it tends to be quite young. Usually women begin taking the stuff that they are going to take it in as early as high school. And it's a form of hormonal modulation, which may or may not be optimal for where you're at at that point in time. And like we talked about, it may be a great idea for you to be having

sexual intercourse without having to worry about having a child. But so many women now that I run into as adults are, hey, I want to really take the best care I can of my body, of my physique, of my performance. And I'm wondering if using exogenous hormones, these dual estrogens or these forms of oral contraception that are quite heavy in the way they modulate the physiology. They're wondering if that's still the best option for them. And so I think just highlighting that this is something that you can have a discussion with your doctor about where you can work through and see which of these options is best. I think that's really powerful because I think a lot of women just think if you're on birth control, it's going to mess your

body composition up no matter what. And that might not be the case. Or there might be some options that could be a little better. Yeah. One interesting thing about birth control is a lot of women tend to carry around more fluid. So it's not necessarily like peripheral edema. So it doesn't necessarily make your wrists and your ankles swell. Some women say they just feel

a little bit more bloated in general and my theory is that um you know the estrogenic activity and some men on trt also feel this with higher estrogen they tend to retain more fluid in all your cells so even like sarcoplasm um has more fluid i've heard that ect steroids can have a similar effect so like terkestrone and beta ectosterone which are very popular right now yeah so uh for some women for example uh potentially let's say there's a a female and she's a power lifter or she like throws shot put or something or just you you know, something where mass moves mass. Yes. A week or two or a month after starting that oral contraceptive pill, she might have an acute

benefit just from retention of more fluid and like intracellularly. Interesting. Sticking kind of with female physiology here, I'd like to talk a little bit about PCOS. And PCOS is something that kind of popped up on my radar, I want to say seven, eight years ago. And I didn't really do much with it because, I mean, if you hear about PCOS now, it's very normal, it's very common. But seven, eight years ago, you didn't hear much about this, particularly in my space, probably much more so in your space, because obviously you're working in medicine. But now I hear about it all the time. And I'd say that about 15% to 25% of the women who apply to work with me or my company in their intake forms tell me they've already been diagnosed as PCOS. So this is something that I think is becoming more frequently diagnosed as we better understand it. I know a lot of women are aware of it, or maybe they're concerned that perhaps they have it or they've heard about it. What is PCOS? How do we diagnose it? Hey guys, just wanted to take a quick second to say thanks so much for listening to the podcast.

And if you're finding value, it would mean the world to me if you would share it on your social media. Simply screenshot whatever platform you're listening to and share the episode to your Instagram story or share it to Facebook. But be sure to tag me so I can say thanks and we can chat it up about what you liked and how I can continue to improve. Thanks so much for supporting the podcast and enjoy the rest of the episode. Yeah, so PCOS is polycystic ovarian syndrome.

However, we actually don't need polycystic ovaries to diagnose it. For example, with the Rotterdam criteria, you can diagnose it with just two points of hyperandrogenism and insulin resistance, so like metabolic syndrome. hyperandrogenism and insulin resistance. So like metabolic syndrome. So, uh, it's a spectrum or a continuum. And like you said, a huge proportion of women have it. Um, you know, just like the Pareto principle, the 10 or 20% with the most severe have 80% of the side effects. So those are the people that find out that they're having fertility issues like subfertile. And those are the ones that really struggle with very high body fat percentage or severe symptoms of hyperandrogenism like hirsutism so bad that they could even grow a beard. So that's a very small percentage of

people with PCOS. Most people that have it never even know that they have it. So because of it is multifactorial and it's kind of chicken or the egg. So even something like a very high body fat can contribute to PCOS. Going on oral contraceptive pills or coming off of them can also contribute to PCOS because after you come off it, you're going to have that spike down of SHBG. Usually you have very low SHBg in pcos and very high lh to fsh ratio also if your mother had pcos or your mother struggled with like insulin resistance and things like that that can also lead to a higher chance of pcos even if you just have a like a genetic polymorphism for a low shbg that can also lead to like one of the types of PCOS on that continuum or spectrum, usually mild,

and it can usually be controlled with lifestyle modifications. Lifestyle modification is usually not to just lose weight and come back in six months. Got it. Which is oftentimes what you'll hear when you're dealing with something like metabolic syndrome. And I want to highlight that because obviously there are people who just have metabolic syndrome. There are people who have metabolic syndrome and like you said, hyperandrogenism. So they are flagged as PCOS. What are some of the lifestyle interventions? Because one of the things I find very common amongst women who are working or wanting to

work with me or wanting to work with somebody in the fitness industry, whether it's a trainer, a coach, a nutrition coach, but their challenge is weight loss with PCOS. What are some of the interventions? Because you said weight loss alone, just lose weight, get out of here, lose weight, come back in six months. That's not very helpful. weight loss alone, just lose weight, get out of here, lose weight, come back in six months. That's not very helpful. What are some actionable things that PCOS women who are interested in body fat reduction can do from a lifestyle standpoint to improve their symptoms and maybe make weight

loss a little easier? Because it's understandably more difficult if you're dealing with any of these things that might be flagged on the Rotterdam criteria. Yeah. So I'll make a little bit of a joke. So think of whatever anybody that has PCOS usually tries to do, goes on an absolute crash diet and tries to do a huge amount of cardio. So usually kind of the opposite of that. So think about the benefits of being PCOS, very low SHBG. You tend to have a normal total testosterone, but a high free testosterone. So you're relatively androgenic and you're able to build up a significant, like compared to someone that doesn't, you would theoretically build more muscle than someone that doesn't. Yeah. And it's not even theoretical. I see this a lot. I've even flagged clients. I've not said,

I think you have PCOS, but I've been like, wow, your strength numbers have increased insanely fast and your body fat is staying largely the same. And then two, three months later, they're like, hey, I'm PCOS. And I'm like, I am not surprised because PCOS women have the occasional tendency to really perform like they might have elevated testosterone. Anyway, continue. Yeah, no, absolutely. It's completely performance enhancing, but the way that they should address trying to keep a healthy body fat percentage is by increasing their metabolically active lean tissue. So when they do that, they're metabolically active lean tissue. So when they do that, they don't have to go on the crash diet. Um, they can do frequent refeeds. Um, they concentrate on resistance training if they're able

to more than, uh, you know, long distance, two hours at a time, cardiovascular training. Sure. And they try to not crash diet to decrease their, um, non-activity. They want to keep their non-activity thermogenesis very high. Gotcha. So those things are especially important for people with PCOS on a case-by-case basis, partly just depending on what the patient likes, working with their dietitian or coach or nutritionist. They could be a candidate for a low glycemic end product diet, which is usually kind of a low carb diet, but a diet that does not lead to like higher fructosamine or glycosylated albumin or A1C. So things like that are, you know, like chips, crackers, cookies, all the things that I like.

Highly refined carbohydrates that might spike your blood sugar, right? Yeah. So they're usually a good candidate for that as well. And those things make sense, right? Because instead of working against what's going on physiologically, you're working with it. And I do find that also for people who are pre-diabetic or type two diabetic, that there's always an emphasis on weight loss, which is fair. And then of course, when the general population thinks exercise for weight loss, they think precipitous amounts of cardio. But resistance training does seem to have some really positive impacts on obviously elevating the amount of metabolically active tissue you

have because you're building muscle. But it's also one of the only ways that you can go about eliciting glute force activity in tissue. So if you're resistant to just insulin in general, or I shouldn't say resistant to insulin, but if your insulin sensitivity has decreased because you're either diabetic, type two diabetic, or pre-diabetic, do you just generally recommend resistance training as a lifestyle intervention for that population too? Yeah, I recommend a combination of, and I actually have prescription pads where I write this out, a combination of cardiovascular or aerobic training and resistance or anaerobic training.

For most people, I recommend at least two days a week of both, if not three or four days a week of both. And then I have a section on there for the, um, non-activity thermogenesis as well. So fidgeting, whatever you want to call it. Um, but, uh, yeah, they are particularly good candidates for that when you have PCOS and maybe you're struggling with, uh, suboptimal fertility or something like that, or even body fat. It's kind of like the analogy I make is it's like getting stuck in quicksand and you're trying to get out of quicksand by uh like dieting down so that you can like it's the quicksand is going to come in before you can diet down you might lose five or ten pounds but the quicksand is going to be right and so you got to dig your way out and the easiest way to do that is with tools and a lot of times medications are

tools so everyone's like well if you're on PC, if you have PCOS, do you need to be on metformin contiguously for your lifetime or is metformin evil because it causes B12 deficiencies and gut problems and dysbiosis of your gut. And the answer for everybody is a little different. And some people are even on topical metformin, but metformin does, it's another one of the things that helps upregulate GLUT4 and GLUT2 both. But yeah, it's a combination of becoming stronger so that you can dig yourself out and also just using the tool. So sometimes people will benefit more from supplements.

Like berberine or something? Berberine, yeah. Inositol. So you have myoinositol, that's more of an insulin sensitatal. So you have myo-anostatal. That's more of an insulin sensitizer. Then you have D-chiro-anostatal. That's more of an anti-androgen. So your anostatal comes in a combination, or sometimes you can get just D-chiro or just myo-anostatal. So if you're a male, you probably want just myo-anostatal. So maybe don't take that anti-and D-chironostitol that your partner has. But yeah, that's another good option.

Dietary fiber is another good one as well. So there's a whole arsenal of tools. Even supplements like berberine or anostitol do have side effects. So you should chat with your healthcare provider about them before empirically starting them. Some people with PCOS will be on two dozen supplements having side effects of almost every one, but at the same time, they won't want to start 500 mg of metformin twice a week. It's ironic to see someone that cares so much about their health that they're trying to avoid the side effects and not realize that there are side effects for over-the-counter products as well.

Absolutely. And I could speak to berberine. Berberine is very potent. Just as somebody who was playing around with it the other day after a large meal, trying to use it as a glucose disposal agent. I was like, I'm carving up. I'm going to pop a berberine with this meal. And I hit the floor. I was so exhausted. I was like, wow, it's very, very potent. It's very effective. And I couldn't agree more with you that we just have a tendency, I think, in the fitness community, in the fitness circle to not be anti-medication, but be pro supplement or pro lifestyle intervention first, which I think is really, really more often than not going to be a good thing. But do not forget that supplements, many of them have a considerable amount of side effects, and you should be doing as much, if not more research on those and how they interact with

some of the other stuff you may or may not be taking than just what they are supposedly going to do positively. Herb Green is an interesting one. So a lot of people know it's a PPAR agonist and each PPAR agonist works a little bit on every receptor. So alpha, gamma, delta, each agonist does work on each receptor. You probably mostly PPAR gamma agonist, but it's still agonized as the other ones as well. And then it's also a weak GLP-1 receptor agonist. It's hard to know if that's clinically significant, but GLP-1 receptor agonists, as a lot of people know, those are, there's lots getting FDA approved

and they're helping diabetics and also helping people with obesity significantly. So berberine's a little bit of that. And then it also appears to help decrease conversion of like choline and carnitine to TMAO in the gut. So potentially it will help with that as well. Might be good if you're taking carnitine to maybe pair that with berberine. And then you were talking about FDA approval for GLP.

Are we talking about semaglutide there? Is that one of the primary drugs that falls into that category? Simaglutide there, is that one of the primary drugs that falls into that category? Yeah. So, Simaglutide is one of the newest GLP-1 receptor agonists, and it comes in three forms. It comes in Rebelsis, and I'm not sponsored by them or anything. If they want to sponsor me, then I'll give a talk for them, but I'm not. So, we're just talking about it because it works. But yeah, Rebelsis is actually a tablet with a new technology to where you can take a pill, kind of like you take

a thyroid pill first thing in the morning, don't eat for a while and your body can absorb it and you up titrate the dose. And it's for, it's right now it's only indicated in diabetics, but it's just a matter of time until it's indicated for obesity as well and insulin resistance and perhaps fertility. Not when you're trying to get pregnant, but before that. And that's a very potent product. There's also a new one called Wegavy. So Wegavy is Ozempic's, I guess, bigger brother or bigger sister. And it is essentially just a higher dose of injectable semaglutide once a week. There is definitely side effects, risk of certain types of thyroid cancer, risk of pancreatitis, risk of gallstones, risk of nausea, vomiting, and puking, especially when you drink more than about two alcoholic beverages or eat a big meal,

it slows the gut transit significantly. So just think about it. It's a balance. If you slow your gut transit to where it stopped, you're going to have reverse peristalsis and probably be puking a ton. And also your gallbladder is not going to secrete anything. So it's going to get clogged up and have sludge and stones. So it's important to balance all those things. Caffeine can help balance that a little bit, as can other things, maybe some Senna, maybe some Tudka or Udka, which a lot of people are familiar with for its cholestasis benefit. But yeah, no, GLP-1s, I do think that they're the way of the future, and we're probably going to have novel compounds and hopefully ones that we don't have to inject more frequently in the near future. I kind of do too. And it's not, you know, I'm somebody whose entire livelihood is theoretically based upon my ability to communicate non-pharmaceutical interventions for obesity and body composition. And I've had numerous clients. One comes to mind that I worked with for a year

and she was doing very well with her lifestyle interventions, exercising, watching her diet, reporting her food logs, her weights, her activity. And in a year when we started working together, she was slightly over 300 pounds. And in a year, she lost about 15 to 20. And in the second year we were working together, she started some agglutide and she's down 60 pounds. And so this is something that clearly works. We've seen it in the literature. I've seen it in practice. And I think it's natural maybe for people to go like, well, just work hard. You don't need the drugs. And it's genuinely not that simple. And if you care about people's health and wellbeing, obesity is not a particularly healthy state physiologically to spend a lot of time in

if you can avoid it. So if it's something that helps us at a population level fight against the current epidemic we're living in, I think it could be really beneficial. Yeah. Obese individuals who are stuck in the quicksand, metformin, berberine, those are shovels and GLP-1 receptor agonists are backhoes. So they have a precipitous benefit. And the patient's still doing all the work by themselves. They just literally have a better tool to utilize. I love that analogy. Sticking with female physiology, we've talked a lot about estrogen. I've talked on the podcast before about the variances in female physiology that we see around the menstrual cycle with elevations in estrogen, progesterone, elevations of testosterone around ovulation,

decreases in some of these hormones and spikes in these hormones around PMS. But something that almost never gets discussed is menopause. And I know that menopause happens at different rates at different ages for different women. And for men, hormonal changes are fairly simple in that testosterone declines semi-linearly with age. What happens to the female physiology during menopause? And why is it that so many women have such a difficult time with weight loss, body composition during and after menopause? Yeah. So menopause is related to a lot of things.

Part of it is when you went through menarche. So when your ovaries started to function, part of it is just genetic. And part of it is likely having to do with your environment what different things that you've been through as far as uh what you've encountered in nature so as menopause approaches the ovaries become less responsive to signals from the pituitary which are fsh and lh and fsh and l rise. At menopause, usually they're around 50, but they can be slightly higher, slightly lower. Antimalarian hormone also starts to decrease as a sign of a general sign of ovarian reserve, approaching essentially 0.0. So as those hormonal changes happen, your estrogen and progesterone peaks

become more blunted. And often the first thing to decrease is actually the progesterone. So in a normal cycle, which is usually around 28 days, around day 21 or so in the luteal phase, your progesterone usually spikes up to six or eight. If it's not spiking up above three or certainly five, you're probably not even ovulating. Even if you have a bit of an LH spike around the time of ovulation. So most people, their estrogen will remain a little bit higher, especially women who have higher body fat and their progesterone will drop off. That's why in the perimenopausal time, a lot of women benefit from progesterone to help maintain that balance as they approach menopause and smooth the transition.

Progesterone in particular. So it's also five alpha reduced, similar to how testosterone is five alpha reduced to dihydrotestosterone to dihydroprogesterone. And then it's five alpha reduced again to five testosterone is five alpha reduced to dihydrotestosterone to a dihydroprogesterone. And then it's five off reduced again to five alpha three alpha. And those things help with sleep. So a lot of women note that they have what we call vasomotor symptoms. And, uh, that's basically, you know, you feel warm and you can't sleep. And that's usually a lot due to the ratio between your progesterone and estrogen.

a lot due to the ratio between your progesterone and estrogen. Also progesterone, specifically the withdrawing of progesterone causes the shedding of the endometrium. So as your progesterone is not as high, it's not going to be like withdrawn as quickly. And that's when women start to note that their cycles take longer because their endometrium doesn't shed because the progesterone just didn't get high enough to withdraw to a point where it would shed. So those are a lot of different things that women note. The progesterone bridge is one thing that's, one trick that's up our sleeve. If the woman also wants or needs, I guess, contraception, a lot of physicians do use oral contraceptive pills, actually, as a kind of almost a mini bridge into potential HRT in the future.

That sounds pretty reasonable. For women who want to ease the symptoms of menopause, because it can be fairly disruptive to deal with some of these hormonal fluctuations, what are some lifestyle and maybe supplemental supplementation form interventions that you've seen to be effective? Yeah. So, you know, the most powerful interventions would obviously be hormones. Increasing your LH can potentially increase release of progesterone from the ovary. So you can consider even doing something like Tonkat or Fidoja. You can also consider doing a progesterone throughout your cycle,

but not during menses. You can also consider doing it just the last five days in order to kind of like prevent the premenstrual symptoms. Some people do it the last five days in order to kind of like prevent the premenstrual symptoms. Some people do it the last five days and during menses if women have significant symptoms during menses as well. But of course, if you do it during menses and the last five days, you're not withdrawing the progesterone. So there's a chance that you'll just delay your menses. So there's a lot of different various strategies of like what to do with your progesterone lifestyle stuff. Um, I always say that the big six is diet and exercise help literally everything. Stress optimization can have a pretty precipitous benefit. So that

can control your cortisol and help with natural progesterone release. Sleep optimization can have a pretty significant benefit as well. So you're going to have more, uh, normal release if your sleep is better. Uh, Matt walk, Matthewer has some amazing info about sleep and the sleep diplomat and his podcast and then um another thing that helps is sunlight being outdoors so that's another good one and then the last one the sixth one maybe it doesn't help as much with progesterone but it's spirit so like soul meditation things like that, depending on what you believe. Those can have a pretty big benefit. As your estrogen and progesterone decline, potentially your serotonin can decline as well.

Okay. So sometimes I'll recommend things like serotonergic probiotics that are proven to increase your serotonin. Your gut produces a lot of your serotonin. 70% or something crazy like that. Yeah. Some people also take Kana, which is a non-selective serotonin reuptake inhibitor herb, which has various risks and benefits. So there's quite a few things that you could do. It just kind of depends. Really, it depends more on your symptoms and not as much on the actual lab values. I do recommend getting the labs. That way we know that it is

related to this or it is not related to this so that we can rule out other pathologies. I love that. And is it fair to say that weight loss might be more challenging because of some of the fluctuations that we're seeing, but it's not impossible, especially if you focus on getting those big six in order and maybe being a little bit more patient, having some grace. Yeah, that's definitely important. Another thing that is important for both men and women to check is their adrenal gland function. So you go through adrenarche and then menarche as a female. So adrenarche is kind of like your first adrenal steroids kicking in. And that includes progesterone and estrogen and testosterone, DHEA and cortisol. So some people will go through

adrenarche simultaneously with menopause. And for those people, it seems to be particularly difficult. Okay. It's good to know. Just to kind of circle it up here, because I've loved the discussion that we've had today, but misinformation in the health space right now is running rampant in conjunction with a lot of really, really good information. And I have found that unfortunately, when it comes to hormones in particular, there seems to be a lot of misinformation. What are some things that people who care about their health, that are interested in hormones, that want to be making informed decisions should be aware of? What are some red flags that they should look for? And conversely, what are some of the better places to get information about this stuff if you're hungry to learn more.

Yeah. So as you mentioned, this industry is very heterogeneous. And even among medical doctors, there's ones that you probably would want to get your information from and maybe would not want to get your information from. And it's the same thing across the board for any healthcare professional, whether they're a chiropractor or a naturopathic doctor or a nurse practitioner or a physician's assistant or a health coach or a guru. But in general, I recommend people at least start with their kind of like their quarterback. So, you know, the patients, obviously the individuals obviously playing on the field, they can have as many special coaches as they want, like special teams to be, you know, like your guru, your health coach, your, you know, nutritionist, dietitian. But the person who kind of like coordinates it all should be a board certified physician or NP or PA, but ideally a board certified physician that you can get along with that kind of like understands your goals and what you want to achieve. It can be a little bit difficult to find,

but there's a ton of good ones out there and it's okay to search for one. So if you go to one and then you go to another one and then you go to another one, it's just like finding a good mechanic or finding a good coach. So a lot of people go to several. And if you find a good one that you're able to keep the rest of your life, that can have a profound beneficial effect on your overall health. I love that. All right, Dr. Gillette, for everybody who's listening, I've seen some of the content you've been producing on Instagram lately.

It's really informative. It's really exciting. I'd recommend that they follow you there. But outside of that, how can they keep up with you? How can they perhaps potentially work with you? What's the best way for people to align themselves with a practitioner like yourself, who I think is one of the good ones? Thank you. Yeah, for now, I'm really concentrated on Instagram at KyleGilletteMD. I'm sure concentrated on Instagram at Kyle Gillette MD. I'm sure it'll be a link somewhere.

Yeah. I'll link it in the, in the show notes. Yeah. Eventually I do want to continue to do more podcasts, um, potentially even have my own, uh, like YouTube channel. Yeah. So I do, I do plan to expand across platforms at some point. Good.

Well, I think you're really good at what you do. I've learned a lot today and I look forward to potentially talking to you again in the future about some other stuff, man. Thanks so much.