Huberman Lab - Dr. Kyle Gillett: Tools for Hormone Optimization in Males

Episode Date: December 12, 2022

My guest is Kyle Gillett, MD, a dual board-certified physician in family medicine and obesity medicine and an expert in optimizing hormone levels to improve overall health. We discuss how to optimize male hormones using a range of nutritional and behavioral tools, exercise, and supplementation (including discussions on tongkat ali, fadogia agrestis, creatine, peptides and more). We explain how puberty and aging affect hormone levels, how to use bloodwork to monitor hormone levels, how hormone health impacts fertility, libido, hair loss, and prostate health, and describe behaviors that negatively impact testosterone levels. We also discuss how to approach prescription hormone therapies, including which biomarkers to monitor when using these approaches and how to optimize synergistic hormones (e.g., growth hormone and thyroid hormone) to support complete hormone health safely and rationally. Dr. Gillett offers numerous actionable tools that can be tailored to specific goals and age ranges to attain and maintain optimal levels of male hormones for overall health, well-being and longevity.  For the full show notes, visit hubermanlab.com. Thank you to our sponsors Athletic Greens: https://athleticgreens.com/huberman LMNT: https://drinklmnt.com/huberman Supplements from Momentous https://www.livemomentous.com/huberman Huberman Lab Premium https://hubermanlab.com/premium Timestamps (00:00:00) Dr. Kyle Gillett & Male Hormone Optimization (00:03:56) Sponsor: LMNT (00:07:43) Puberty: Height, Resistance Training, Childhood Obesity (00:15:14) “First” vs. “Second” Puberty (00:17:17) Hormone Optimization & Blood Work (00:22:14) Diet, Exercise, Sleep & Hormones (00:28:23) Hormones, Stress, Social Connection & Purpose (00:32:19) Hormones, Supplementation & Medication (00:34:08) Determining Individual Hormone Levels, ADAM Questionnaire (00:40:35) Libido, Masturbation, Pornography & the Dopamine “Wave Pool” (00:47:56) Sponsor: AG1 (00:49:46) Sustainable Exercise Regimen for Hormone Health (00:58:12) Testosterone Replacement Therapy (TRT) (01:01:02) Supplementation: Creatine & Hair Loss, Betaine, L-Carnitine & Allicin (Garlic) (01:11:45) Vitamin D, Boron; SHBG & Free Testosterone (01:15:34) Sponsor: InsideTracker (01:16:39) Tongkat Ali (Eurycoma longifolia; Longjack) & Steroid Pathways (01:22:09) Fadogia Agrestis & Testosterone  (01:26:32) Optimize Growth Hormone & IGF-1: Diet, Fasting, Supplements & Exercise  (01:31:52) Optimize Thyroid Hormone: Iodine & Goitrogens (01:33:56) Peptides: Growth Hormone, Tesamorelin, Ibutamoren & Gut Microbiome (01:42:06) Testosterone Therapy (01:47:03) Prescriptions & Hormones: Human Choriogonadotropin (HCG), Clomiphene (01:52:56) Testosterone Therapy + HCG, Fertility & Temperature (01:55:30) Hormone Health Q&A: Marijuana, Nicotine, Cycling, Pelvic Floor, Alcohol, Fat (02:06:08) Prostate Health & Tadalafil, Prostate Specific Antigen (PSA) (02:09:56) Hair Loss & DHT; Turmeric & Curcuminoids (02:18:13) BPAs, Phthalates & Hormone Health (02:21:55) Zero-Cost Support, YouTube Feedback, Spotify & Apple Reviews, Sponsors, Social Media, Momentous, Neural Network Newsletter Title Card Photo Credit: Mike Blabac Disclaimer

Welcome to the Huberman Lab podcast where we discuss science and science-based tools for everyday life. I'm Andrew Huberman and I'm a professor of neurobiology and Ophthalmology at Stanford School of Medicine. Today my guess is Dr. Kyle Gillette. Dr. Kyle Gillette is a dual-board certified physician in family medicine and obesity medicine and an expert in hormone optimization. He is an MD, that is a medical doctor, and he treats patients with a variety of backgrounds, ages and goals. Today we discuss male hormone optimization. We discuss behavioral tools, nutrition-based tools, supplement-based tools, prescription

drug-based tools, and their interactions in determining overall levels of testosterone, free testosterone, dihydrotestosterone, estrogen growth hormone, thyroid hormone, and many other hormones that impact mood, libido, well-being, strength, cognition, and various psychological factors. We covered hormone optimization in both men and women in previous episodes of the Hubertman Lab podcast. But today's discussion is different. Dr. College-Alett offers very specific recommendations for people with different goals and of different ages. And we get deep into the weeds of, for instance, how does one know whether or not their testosterone is optimized or not, how often to test for specific hormones,

such as testosterone and other hormones, and really how to gauge how good one should feel. This is something that's often overlooked in discussions about hormone optimization or health optimization of any kind for that matter. For instance, people will talk about reduced libido and discuss whether or not testosterone levels are to blame. But how does one calibrate their libido in the first place?

That is, how does one know whether or not their libido is normal, too low, or too high? We also discuss, for instance, whether or not hormone optimization should be pursued continually throughout the year. For instance, whether or not you should cycle on and off supplements and or prescription drugs, geared towards hormone optimization, and we discuss the behavioral foundations of optimal hormone function. These are things that every male should be doing and various things they should actively avoid if their goal is to have healthy hormones and to quote unquote optimize their levels of every hormone from growth hormone

to testosterone at any stage of life. And while today's discussion is about male hormone optimization, I want to emphasize that we discuss all the various ages for male hormone optimization. So for those of you that are parents, for those of you that are young, those of you that are middle age or old or teenagers, we explore adolescent, puberty, teen and late teens, early adulthood, adulthood, and into the late geriatric ages.

So regardless of your age and whether or not you are male or female, today's episode ought to be of interest to you. I should also point out that we will soon also be hosting an expert guest on female hormone optimization. One thing that I'm certain people of all ages and biological sex will enjoy about today's conversation is that we also get into descriptions of how psychology and life events impact hormones and how hormones impact our psychology and the way that we show up to various life events. So today is really a broad overview that goes all the way down to fine details about male

hormone optimization. And I'm certain that by the end of today's episode, you'll have an immense amount of new information about how this endocrine, that is hormone system in your body works, and how it interacts with your brain and other tissues, and many, many actionable tools that you can pursue, regardless of stage of life. Before we begin, I'd like to emphasize that this podcast is separate from my teaching and research roles at Stanford. It is, however, part of my desire and effort to bring zero cost to consumer information about science and science-related tools to the general public. In keeping with that theme, I'd like to thank the sponsors of today's podcast.

Our first sponsor is Element. Element is an electrolyte drink with everything you need and nothing you don't. That means plenty of salt, magnesium, and potassium, the so-called electrolytes, and no sugar. Now, salt, magnesium, and potassium are critical to the function of all the cells in your body in particular to the function of your nerve cells, also called neurons.

In fact, in order for your neurons to function properly, all three electrolytes need to be present in the proper ratios. And we now know that even slight reductions in electrolyte concentrations or dehydration of the body can lead to deficits in cognitive and physical performance. Element contains a science-backed electrolyte ratio of 1000 mg, that's 1g of sodium, 200 mg of potassium and 60 mg of magnesium. I typically drink element first thing in the morning when I wake up in order to hydrate my body and make sure I have enough electrolytes. And while I do

any kind of physical training and after physical training as well, especially if I've been sweating a lot, if you'd like to try element, you can go to drink element that's LMNT.com slash Huberman to claim a free element sample pack with your purchase. Again, that's drink element LMNT.com slash Huberman. And now for my discussion with Dr. Kyle Gillette. Dr. Gillette, great to have you back. Great to be back. Thank you. I'd like to begin with a question about one of the most mysterious and important phases of life, which is puberty. I've long wondered whether or not how quickly somebody goes into puberty, so at what age? And how long puberty takes, so how brief or protracted that puberty is for them to acquire

the so-called secondary sexual characteristics, things like hair growth on the face, for males, changes in bone and muscle, density and growth, etc. When I was in middle school and high school, I noticed that some people transitioned into all that very fast and some people took a long time to acquire those characteristics. Can we learn anything about ourselves, our hormones, and maybe even how long we're going to live based on the time in which we enter puberty and how long it takes us to progress through puberty. I guess that also raises the question, does puberty ever truly end? There are many takeaways from puberty. Some of the actionable items from it is, yes, it can and does affect your adult height and also stature and also body composition.

height and also stature and also body composition. So puberty is a time, and if we're talking specifically about males, think of it as a time where if you have obesity as a child, you could potentially use that time to change your lifestyle and habits and reset things and it is a bit easier. It's almost like a free injection of testosterone and metabolism and drive and effort into your life.

There's a wide variation in how quickly puberty goes through, so there's stages called Tanner stages, which we don't necessarily need to get into, but if you enter puberty very early, then it can decrease your adult height or stature. So for a given male that enters puberty at 13 versus a male that enters puberty at 15, can we say that the guy that entered puberty at 13 is going to be shorter than the guy that

entered puberty at 15, or it's not quite that straightforward. If they are identical twins and the individual who entered puberty at age 13 also finished puberty when all the way through the Tanner stages, and if you do a bone scan, which I believe is usually done on the left to wrist, and it says, yes, your growth plates are mostly closed, you're not going to grow more than a couple inches of height after that. Okay. Just a related question. When I was growing up, it was thought, or at least people would say, that resistance training in particular, lifting heavy weights could stunt one's growth. Is that true? Or false. It is false when you're talking about just lifting heavy weights. Dirty bulking certainly has the potential to stunt one's growth for two main mechanisms.

Could you define dirty bulking? So dirty bulking is eating an excess of calories, not just to acquire lean, metabolically active body mass or get stronger, but a purposely acquiring body fat. So, purposely acquiring muscle and fat by overeating and lifting weights can stun one's growth? Do I have that correct? Correct. So, it does two things.

If you're doing it as a very young child, that fat can become leptin resistant and it can produce more leptin. And that leptin can activate the hypothalamus, which activates the pituitary, which releases genetatropins, which basically just increased testosterone and estrogen earlier than it otherwise would have. It's the same mechanism behind why childhood obesity causes early puberty. Interesting. I do remember a paper published in Science magazine. I believe it was focused mainly on females, but showing that when enough body fat accumulates, the hormone leptin is secreted and that triggers the onset of puberty.

Correct. Given the increase in childhood obesity that we're observing now, are we seeing an earlier onset of puberty in males and females? Yes, in both males and females. Not to get too tactical, but there's a G-protein coupled receptor on the hypothalamus and leptin directly binds it, so it does appear directly causatory and not just correlation. Okay, so if I understand correctly what you're saying is for a young guy, let's say 13, 14 who wants to really bulk up and deliberately, deliberately, excuse me, overeats and is doing their squats and deadlifts and bench presses and really trying to get big, they will get big, but only in the lateral dimension, they are, they're effectively limiting their total height and

it can shut down the long bone growth of their limbs. Is that correct? Correct. The growth of the long bones is mostly related to the estradiol alpha receptor, so basically one of the receptors for estrogen, which can be secondary to early puberty, and also is related to body fat because you have that conversion of testosterone to estrogen. So can we assume that if a young male wants to get into resistance training that bodyweight exercises are probably okay and maybe even some weight training, kettlebells, etc. But that they should avoid doing so called dirty bulking, trying to deliberately

gain weight up until what age, until puberty is over? I would say an individual should limit the amount of abnormal body fat accumulation or dirty bulking indefinitely throughout their entire life. So again, if I understand correctly, that recommendation to avoid deliberate weight gain or rapid weight gain is not just to allow an individual to reach their maximum height, but also to avoid laying down a lot of body fat cells. Correct. Correct. The balance between that is when you are going through puberty, you are able to add a lot of lean body mass, not just muscle mass, but bone mass and other mass as well. I started lifting weights when I was 16 and I confessed I trained pretty heavy at times.

I don't know whether or not I would have been taller than I am now, but when I started that training, I had already reached what was at least close to my predicted height. I can't say that I deliberately waited until I grown. It just so happened that I stumbled into the I can't say that I deliberately waited until I grown. It just so happened that I stumbled into the weight room and found that I liked it at age 16 at which point I was already the height that I am now. So in any case, what I'm hearing is that laying down a lot of excess body fat is not a good idea.

What if somebody grows up chubby or fat? For whatever reason, reasons related to the eating patterns in their family, maybe some genetic reasons, is it safe and or wise for a young person? So let's say somebody who's around the age of puberty, or even younger, or in their late teens to be dieting and actively trying to lose body fat, is that safe? Under the supervision of a physician, it is certainly safe to change your body composition. In pediatric obesity medicine, you're often talking about a decomposition or a re-normalization of the growth curve compared to peers.

Right. Thank you. So, as you may have sense, we started chronologically with puberty, and I know that there's another puberty that even precedes the puberty that we're all familiar with. Maybe if you want to just briefly mention that because I was talking with you about this before, we started. The puberty that I'm most familiar with, and I think most people are most familiar with, the acquisition of deepening of the voice, growth of muscle and bone, body hair acquisition of libido and things like that, that's actually the second puberty

that we all go through. Maybe just mention for us and educate us on the first puberty, and I think most people will be hearing this for the very first time. The first puberty of everyone's life is the first three months of their life. You may notice that your baby has more acne in the first three months, and that they also have, in general, just more changes related to androgens and estrogens, perhaps oilier skin, even more genetic urinary, like genital growth during the first three months. And this is mostly due to DHEA, which is an adrenal hormone. The second puberty or the puberty that most people know of actually starts that same way

as well. It's called adrenarchy, and it's when the adrenals kick in, I guess, for the second time. Is there a standard age or age range in which the testicles descend in males? Usually before birth. It is not uncommon to have one or even two undistanded testes, but there is a risk of testicular cancer, especially if they are not fixed early and also heat damage to the testee. Well, thank you for that coverage of the two pubertyes. Early in life, I imagine some of our listeners are probably still in one or the other puberty. The ones that are in the first puberty obviously

aren't aware that they're listening to this podcast, but maybe they'll be embedded in their subconscious. But some listeners probably are still in puberty, but I think everyone can remember back to their puberty and roughly when they first entered puberty and how quickly they aggregated the secondary sex characteristics. I'd like to turn now to a general question

about what all males ought to do in order to optimize their hormones. So, if you could just list off the things that all males should do on a daily basis, weekly basis. I mean, should guys in their teens and 20s be getting their blood work done? Should they be taking supplements? We already talked about weight training. What should they be doing?

What should they avoid doing if the goal is to have a long arc of healthy hormone optimization throughout the lifespan? There's many things that you should do. An analogy that I often make is when there's a brand new car that comes off the assembly line, you do a full scope of diagnostic workup, hook it up to the computer, and I think we should do the same thing with humans as well.

Deer and puberty, obviously you're a functioning human, but I would say there's still development. And I think that the human always develops. I don't think development ever ends, but you want to monitor that progress across a person's lifespan. So, for blood work, what would be the earliest, let me put it this way, if blood work didn't cost anything, and everyone could get it, when would you want to see everybody get their blood work done for the first time? Obviously, individuals under the age of 18 should talk with their parents about this, and as long as the parents and the child

agree and the parents are on board with this as well, you can start getting blood work. Often a child will come in with complaints of either precocious puberty or delayed puberty, and this individual might be nine, or this individual might be 15 for a healthy child when they're going through kind of their later Tanner stages, which is four and five. So they've developed several secondary sexual characteristics. They might have hair growth or starting to notice more beard growth. That's a good time to do it.

If you're concerned with stature or height, or if you're not tracking along where most members of your family have, not just their height and stature, but also the timing of the puberty, then that's time to get laps. Right, so if I could travel back in time, I would have gotten my blood work done for hormones and lipids and everything else at 18. I fortunately didn't know where and how to get that, and I didn't have any pressing clinical issues. And so I think the first time that I got my blood work done, I was in my late 20s, maybe even my early 30s, and I'm still dying to know what my blood work was when, for instance,

I was 17 and I felt a certain way. And I confess that in many dimensions, I actually feel better now at, I'll be 47 soon, at 47 than I did in my teens and 20s. And I think it was more on the psychological side, I think that, but in terms of just understanding why we felt great or why we felt or feel terrible or not so great, I think blood work is extremely informative. What do you think are the key things to look for in blood work?

I mean testosterone is always the topic that comes up in the context of male hormone optimization, but certainly there are a lot of other hormones that are important as well. And with testosterone, you want to get either testosterone and SHBG or a free testosterone. Could you define SHBG for our listeners please? It is sex hormone binding globulin.

It is the protein that binds up all androgens and estrogen in the body. So the stronger the androgen, the stronger it binds during puberty, strong androgens, especially DHT, which is the strongest bioidentical androgen has a huge role, a prominent role in secondary sexual characteristics. And if your SHBG is very high,

then your DHT can run higher because it's not metabolized, but there's not quite as much free DHT. So you wanna balance between a high enough free DHT and a high enough total DHT. And obviously these blood tests are going to have to be read and interpreted by a qualified physician, most people aren't going to be in a position to evaluate them properly or at least not with the full depth that

they could if they had an MD like yourself looking at them. Okay, so everyone should get blood work as early as possible, depending on their budget and availability. What should everybody do in terms of monitoring those markers? So assuming that there's no major intervention, how often do you recommend that people get their blood work done? Let's say, let's take an individual who just turned 18,

they just got their first set of blood work, they'll probably find something in it that they may want to optimize using shared decision-making with their physician. Usually a good follow-up is about six months. Okay, so twice a year getting blood work done and having a physician evaluate it, that's on its reasonable to me. And for those that didn't initiate this at 18, such as myself, it's the best time to

start then would be as soon as possible. In terms of the other things that all male should do, meaning all males of all ages, puberty and beyond, should do, what are some of those things? So on a daily basis, maybe you could just take us through the arc of a day and push out some of the protocols that you use or the things that you like to see your male patients use in order to try and optimize their hormones status.

I'll briefly touch on some of the lifestyle pillars to start diet and exercise or the first two. In puberty, sleep is particularly important, of course. But with diet and exercise, throughout a lifespan, you want to not exclude things that are helping you. For example, during puberty, if you're consuming dairy, and then all of a sudden, you cut out all dairy,

dairy can help increase IGF1 and free IGF1. And just for our audience, maybe you just mentioned what having enough IGF1 can do for us that's beneficial is. It helps you grow. It helps with genital development, secondary sexual characteristics, and long bone growth, skin growth, hair growth, a host of things. So getting an array of nutrients that include dairy, what other sorts of nutrients are important during development?

You want to have adequate vitamin D. Vitamin D helps with testosterone production. It helps, again, with bone mineralization and stature after an age about 25, and there's not a strict cutoff, but up to about an age of 25, optimizing your growth hormone and IGF1 helps with bone density and bone growth. So from the dietary standpoint, you want to have enough free estrogen, not too much when you're growing, but you want to help basically stockpile bone to prevent a risk of osteoporosis or thin bones fractures when you're older. Well, someone who broke his left foot five times while in high school, I can say, whatever, young people can do to optimize their bone density would be great.

That problem seems to have resolved itself over time, but I don't know. Back then, I did a short run as a vegetarian, but I've always been an omnivore. I realized that some of this relates to ethics and food allergies and things of that sort, but would you say that on balance that most people would benefit from eating a combination of quality proteins from animal sources and non-animal sources, fruits, vegetables, and starches. I mean, what do you think, for instance, about people following a pure carnivore or a very pure vegan diet in their 20s and 30s?

In their late 20s, it might be a reasonable option. In early 20s and certainly teens, it is a horrible idea because it is likely to significantly decrease your free endrogens. and certainly teens, it is a horrible idea because it is likely to significantly decrease your free endrogens, so you will have less testosterone acting on receptors through the body. Are there any other micronutrients or macronutrients that people in their 20s and 30s should emphasize? We haven't really touched on fatty acids or fiber too much.

Fiber is going to be paramount in kind of like setting your set point of your gut microbiome, the rest of your life. There is prebiotic fiber, which you can think of as fish food for your good gut microbiome. Your gut microbiome is kind of like an aquarium or a fish tank. No, I'm just thinking about goldfish swimming around in that. Goldfish eating people, don't eat goldfish people. Yeah, thank you. Live or dead. Yeah. But any fiber or food that you're putting in your gut, it's either going to, it's going to skew your gut microbiome towards something that is more beneficial or more detrimental. And would you say that the prebiotic fiber and getting essential fatty acids, that would be important to do throughout the lifespan or just for the people in their 20s and 30s.

Throughout the lifespan, particularly important in the teenage 20s, 30s, because that helps with brain development. You're certainly more of an expert than me when it comes to brain development, but it does continue to develop really throughout the lifespan, but certainly through the 20s and 30s as well. About taking a multivitamin while you're growing up. So many people do that. Is it necessary? Is it useful? And if it's not necessary, is it safe to do anyway? It's generally safe to do anyway. I do not think everybody needs a multivitamin. The more exclusionary your diet is,

for example, if you have celiac disease or if you're planning on fertility soon, then perhaps it's more reasonable to take a multivitamin. In a previous discussion of ours, I asked you about caloric restriction and testosterone. And if I recall correctly, the idea was that if somebody is overweight, they have an excess fat adipose tissue,

then getting rid of some of that adipose tissue by through caloric restriction and exercise, provided it's done not too fast in a healthy way, is going to be beneficial for testosterone in the long run. But that for individuals who are not carrying an excess of body fat, caloric restriction is actually going to lower testosterone. First of all, do I have that correct? And second, are there any

addendums to that that you'd like to give us now? That's correct. If you look at an individual in a caloric deficit, several changes will happen. One is that they'll have less building blocks for hormones. Another is that they will be in a catabolic state more often, so that balance of an ableism and is that they will be in a catabolic state more often so that balance of an ableism and catabolism will be different. They'll likely have less signaling from growth hormone and IGF1. And they'll also have the high SHBG that we defined earlier as the binding protein. So there are free androgens and free estrogens will go down.

Okay, so we touched on sleep being critical. I would say throughout the lifespan, trying to get enough quality sleep, at least 80% of the nights of your life. And the other 20% are just what happens when there's noise outside or you're stressed, it just you have an exam or you're having a great time for whatever reason, a lot of good reasons

to lose some sleep now and again as well. But so we have sleep, we've got nutrition, and we touched on that. We'll get back into supplementation. What are some of the other pillars of creating the proper environment for hormone optimization? Stress is probably the next one, during both puberty, but also the 20s and 30s. Individuals are figuring out how they want to cope with stress and also figuring out what they want to choose to put their effort into.

So if someone is overstressed, then they can have, it can put all the other lifestyle pillars and then they stop dieting well, they stop exercising and everything else can go as Q. There is also some degree of social component to this, so perhaps I need to add a seventh pillar of social. You know, during your 20s and 30s, you may be forming a family as well.

Perhaps you have children and the health of the family unit is going to be vitally important. Not only, not necessarily directly for hormone optimization, but it's going to throw everything else off of it's off. And for people that are not starting their own families in their 20s and 30s, can that social connection be extended to friendships and work relationships as well? Absolutely. In fact, if someone's not starting a family, it is just as

concerning, but for other reasons. Each individual is going to have their close group of family and friends. And if someone does not have one of those connections, that's when things can potentially get bad, not just for them individually, but also society. So when you say stress, you mean learn to manage your stress. What does that look

like? I mean, if a patient, you know, has high blood pressure, or even if they don't, you just sense that they're stressed. They've got a lot of pressured speech, or they're not feeling well, or communicating that they're not doing well. What are some of the things that you recommend in order to try and ameliorate that stress? There's different mindfulness or relaxation techniques going outside can often help with this as well. Dietary changes and exercise can help with this too. Some people like prayer or meditation and a lot of people like counseling or therapy or even just talking openly with a family member or a friend.

What would be some of the other pillars for hormone optimization? Here I feel like we're not just talking about people in their 20s and 30s, but again, we're wrapping our arms around, basically, puberty onward. I mean, I mean, gosh, I was looking back. I started meditating pretty early. I started weight training and running early. I gave some thought to my diet in high school, but really it was in college that I started thinking more about what I was ingesting and why and trying to do better there.

But people are coming to the table at different stages of life and trying to optimize for hormones. So, what would be some of the additional things that everybody should do? Everyone should get outside and find a movement pastime to last a lifetime. You're going to get sunlight, you're going to get some degree of heat and cold exposure, and you're also just going to move more. Being in an artificial environment, where there's artificial lights, artificial air conditioning is going to have many effects on your body. So that's vital. Another one is finding what your purpose is in life. So I call this spirit,

but it's really just the self-actualization component of Maslow's hierarchy of needs, which is basically your physical needs, your mental needs, and then your purpose in life, what you really like to do. Picking some goal or target. I always say that you don't have to stick to the same goal over time.

Certainly I haven't, although I got started early in the science game and I'm still in it, the idea is not to pick the end goal, it's to pick A goal and then once you reach that goal to assess and then pick another goal and so on. I think sometimes when people hear about picking a purpose of like, oh my goodness, I have to define, sort of like naming oneself that you actually can change your goals and purpose over time. This is terrific. Would you suggest that people actively use

or avoid supplementation prior to doing all these other things? I'm somebody that likes to throw the kitchen sink it things, but I also like to do things pretty systematically. So I always say behaviors first, then nutrition, then supplementation, and then maybe, if and only if there's a real need, and of course working with a doctor prescription drugs. But, you know, there are probably people in their 20s or 30s,

maybe even in their 50s, that aren't feeling great, and they want to do something in order to be able to train more, or to feel more confident to seek out social connection. They try and go about the whole business from the other side as well. But what are your thoughts on that? I see supplements and medications as very similar. One's prescribed and one's not. In general, medications have more side effects or potentially stronger therapeutic with more

efficacy, but they are just tools to reach an end goal. So depending on the goal, if there's an individual that's an athlete, then certainly they should consider supplementation, or if someone desires optimal or a very high level of cognitive performance, they should also consider supplementation. At the same time, food is medicine, and a lot of the benefits you can get in supplements, you can get in food as well. Yes, it depends on how much time and energy you're willing to spend, and also finances. You know, I know that when I was in college, I could afford just a few supplements, and they're basically way protein and some fish oil. I was fortunate that I was pointing the direction

of those things and some creatine. I couldn't afford much else. Over time, of course, I could afford more, but it really does often depend on finances. Before we get into some specific recommendations to optimize testosterone, estrogen, thyroid, growth hormone, etc. I want to ask you a question I've been wondering about for a long time. So often in the discussion about male hormone optimization, people will say, well, if your libido is suffering, you might want to be concerned about testosterone or even estrogen, right? Because we know that estrogen can impact libido as well.

Sometimes having estrogen too low is detrimental for libido. Or people would say, you're not recovering from workouts or you're feeling kind of depressed. The problem is it's all subjective. So how does one know whether or not their recovery from workouts, their energy, their confidence, their libido is within a healthy range? I mean, obviously for people in a relationship, they can know whether or not their libido matches the sort of cadence of the relationship in their partner. But how should people think about this and maybe it starts to talk about it?

Because one of the big differences, I think, between males and females is that because females have a monthly cycle, they are familiar with the changes that occur in their hormones over time because every 28 days, those hormones are changing dramatically in ways that impact their physiology and psychology. But for males, I feel like they're sort of a a a dearth of language to get into the more subtle aspects of this. It also has to do with privacy issues and people feeling like they don't want to overshare too much, not knowing what's appropriate to share. But when you talk to a patient who's in their 30s or maybe even their 70s or 60s doesn't

matter, a male patient, what are you listening for? And I know you're not a psychiatrist, but what are your ears tuned to in order to try and figure out whether or not this person could really use some help with hormone optimization or whether or not something else, or maybe they're just doing great and they don't realize it because they're placing demands on themselves that are excessive. You want to use a lot of open-ended questions. This process is called motivational interviewing. And your goal is to listen to the patient and not plant an idea in their mind that they can follow because everybody is going to have a different goal. Some people are better at reading their biofeedback or telling how they feel on a daily basis. There is screening questionnaires designed, for example, an atom questionnaire to look at men's health and hormone related health. It example, an atom questionnaire to look at men's health and hormone-related health.

It's called an atom questionnaire. AdAM. Correct. Is it available online that people could administer it to themselves, although we don't want people making clinical diagnoses of themselves or anyone else, is it that sort of exam? It is. Interesting. I don't believe it is a clinically validated tool, like an AICVD, which is like a risk of heart attack and stroke

tool, or many other tools. There's one for depression, there's one for anxiety, they're called PHQ9 and GAT7 respectively. But anyway, there is often an in the Adam questionnaire and what you hear from the patient if you are a very careful listener, is often different. Can you give me an example of some of the questions on this Adam questionnaire or the sorts of motivational interviewing that you might do? So, Sam, your patient, we sit down, what sorts of questions would he ask to probe

these kinds of dimensions of hormones? Questions about libido, questions about athletic performance, questions about motivation, and often the patient will answer one thing, but what you hear from them subjectively is far different. Interesting. Can you give me an example of a question? I'm happy to be the guinea pig here.

A classic one is a guy comes in, and a lot of times they say, oh, no, the wife made me go to the doctor. I go once a year, that's it. I don't want anything. I don't want any medications. Their screening questionnaires might be zeroes across the board. So nothing, no issues. They're apparently in perfect health. They talk to you for a while. They get some rapport. They like you. And then right as you're finishing the visit and about to go out the room, they mention that their libido isn't quite there and they're having a little bit of ED as well and perhaps they're

even having some chest pressure tightness. I see. So, right as you're leaving the room, a patient will tell you that they're having some sexual side effects or not side effects, they're having some sexual challenges. And then they'll mention chest pressure. Is the chest pressure a sort of general decoy for that it's got gotta be my heart, or is it related to the other things they're reporting? It can be related. In fact, erectile dysfunction is known

as the canary in the coal mine. So coal miners would take the canary down and the canary would die before the coal miners would have, I believe, carbon monoxide poisoning. And often, one of the causes of ED is plaque buildup, which can happen in the coronaries as well. But sometimes they notice the symptom and the genitals before they do in the coronaries. So for such a patient, let's say that patient was a young person where plaque buildup in

the arteries and veins is not all that likely, if they're, let's say in their 20s or 30s, what would be your next step of the interview at that point and what would you consider? Would you immediately order labs for that person to try and rule out any kind of actual hormone level deficiency? I certainly would order labs. There are some individuals that are very similar and they come in and they have the same symptoms.

And one individual might have a very, very high testosterone. And one individual might be severely hypogonadil. So there's a big difference between the subjective and what the labs look like. So I certainly order labs. You also ask them about if it's situational or not, you ask them if they have ED if they're, you know, they ask them about their habits.

You even ask about porn and masturbation and all these issues. And of course, it's between the doctor and the patient. And depending on what they tell you, you can often determine if there is a situational component. Some people call it psychogenic ED, but I don't love the term psychogenic ED because it kind of puts some blame on the patient's mind. But a lot of the time that is

the case, there's even a test, and this is very rarely ordered, but it's called a nocturnal penile to a messence. Is it true that there are periodic erections during sleep? Yes. Yeah. So you basically put a cuff to see if you're having a normal sized erection during sleep. And I believe about 90% of the time they do that test, they are indeed having erections. Which would point to this psychogenic origin of whatever challenges they're having in terms of sexual interactions. You mentioned porn and masturbation. This topic has come up a bunch of times on this podcast and on other podcasts.

I've gone on because of the relationship between dopamine, sexual motivation and sexual behavior. And I've been of the pretty strong stance that while I'm not judging porn or masturbation, it can create a brainwiring situation where males in particular essentially teach their brain to be aroused by watching other people have sex as opposed to being the first person actor in sexual interactions. So in that sense, you know, that's more about the brainwiring and neural plasticity and dopamine, but what are your thoughts on porn and masturbation as they relate to hormones? I mean, this is a big debate on the internet.

In fact, one of the most common debates is whether or not masturbation increases or decreases testosterone and males. Certainly, it will decrease motivation to go find sexual partners. We know this. And there are more and more data on this all the time. In terms of the effects of pornography and masturbation, and here I suppose we need to be somewhat specific and operationally to find what we're talking about. We're talking about porn and masturbation to the point of ejaculation, right?

Because my understanding is that the ejaculation and orgasm associated with it cause an increase in prolactin, which blunts libido for some period of time. The duration of that will vary from person to person in circumstances to circumstance. But basically, all of this points to the fact that foreign masturbation can really limit libido in the real world. And to me, pornography and the screen is not the real world. The screen exists in the real world. The real world doesn't exist in the screen.

That's an accurate statement. And prolactin does have a significant acute increase after ejaculation. It does, to some degree, after orgasm as well, but prolactin acts on the pituitary to inhibit the release of the hormones, LH and FSH, of which LH can increase testosterone. So this may be one of the cases where the dose

makes the poison, and if it is a very frequent habit, certainly daily or more than once a day, it would be very detrimental from a hormonal component, not even taking into account the neurowiring. Listen, I think it's terrific that you've actually defined frequency, because this is the problem on the internet or even in the doctor's office, you'll see descriptions about pornography being dangerous for certain things or detrimental to hormones, you'll say frequent, but what's frequent?

So you're saying daily or multiple times per day would be potentially detrimental to the hormone profile of a male of essentially any age. And that's just for masturbation. With pornography, with porn use as well, it would likely be worse. And why is that? Just this, the sort of dopaminergic drive of the stimulus, just a really intense visual stimulus. Dopamine sensitivity. I think that using the analogy of a dopamine wave pool, it would deepen the pool, but not

increase your supply of dopamine. Maybe you could describe the dopamine wave pool because I think it's such a powerful way of thinking about dopamine and what dopamine does. In fact, I've always credited you when I've done it, but I've generally stolen your analogy of the dopamine wave pool because it's so astute. The dopamine wave pool describes the natural variation of ups and downs in your dopamine or your motivation. And in the wave pool, depending on how high the peak is, you often have a deeper trough. So you do not want to hide a peak.

In addition, if your peak is very, very high, for example, when you're using many substances, like cocaine or like amphetamines, your dopamine can go so high, you lose almost all the water from the wave pool. And then when you crash from that, not only is the trough low, you have less dopamine in the pool to begin with. The dopamine receptor is extremely

sensitive, as is the GABA receptor, which is an inhibitory receptor, whereas dopamine is technically a stimulant more related to adrenaline or noradrenaline. The depth of the pool can change very quick. So you want to have that happy medium where you're fairly near the top, but you're not so near the top that the depth of the pool is going to go down. So if I interpret that in the context of this discussion about libido sex, porn or masturbation, if somebody has a very intense sexual experience, and not here, we're not necessarily talking about an intense orgasm. We're talking about just a lot of sexual experience. And not here, we're not necessarily talking about an intense

orgasm. We're talking about just an, you know, a lot of intense visual. So very, a lot of intense imagery or auditory input or both, that is going to lead to a situation where dopamine is going to be depleted afterwards. A guest on this podcast before my colleague at Stanford, Dr. Annelemki, who's an expert in addiction, talked a bit about this, the sort of sea sawing, I hear we're talking about a wave and a crashing out of the water from the wave pool there. It was a sea sawing from pleasure and pain. It was gonna be a longer and deeper period of lack of pleasure following that.

And I think a lot of people think, oh, well, that's great. You know, they want the intense experience, but if that intense experience is coming from pornography and masturbation, or I suppose coming from, you know, high adrenaline activities like, you know, life, life risking parkour hanging off the side of a building, it inevitably is going to lead to depressive episodes, low libido episodes that follow. Is that right?

Correct. In a similar physiologic way to withdrawal from stimulants like amphetamines. Now is sex with a partner different because there are many people who are chasing more and more intense experiences with a partner as opposed to through pornography and masturbation. Again, here we're talking about all ages and I should always say, anytime we're talking about sex with a partner, we're talking about the four conditions that I always lay out on the human lab podcast, we're talking about consensual age appropriate context appropriate species appropriate interactions. Yeah, and this is also a case where the dose makes the poison. So if there's

you know, obviously meeting all those criteria, if they have one preference, that for both of them is a positive experience, then that is likely okay. You're not gonna be able to maintain dopamine over a certain threshold for a long period of time. So they're very well maybe a crash from the experience as well, and the crash may be different

in one partner than the other. Interesting. Oh, I'll try an analogy to food. You don't have to serve the banquet meal seven nights of the week, maybe just two. Is that right? And there are other delicious foods out there. Yes, we use that analogy. That is very reasonable.

Okay, not trying to be PG-13, just trying to parsimony, Occam's razor, the ability to describe a lot of things in a few words. I'd like to return to the key things that people should do, or I should say, the key things that men should do to optimize their hormones. So we talked about getting some movement, getting some sunlight, getting quality social connection one way or the other,

avoid excessively frequent masturbation and viewing pornography. And for some people, zero might be the optimal number. And I keep coming back to this for most people, for most people. Interesting. I feel so fortunate to have grown up prior to the availability of internet pornography. I've never been a consumer of pornography. I've just not been my thing.

But I hear so often from males of all ages about their addiction to it, their affliction by it. It's really a serious issue, and that's one of the reasons why I'm grateful that you're willing to talk about this and your clinical experience with these patients. I'd like to take a quick break and acknowledge one of our sponsors athletic greens. Athletic greens, now called AG1, is a vitamin mineral probiotic drink that covers all of your foundational nutritional needs. I've been taking Athletic greens since 2012, so I'm delighted that they're sponsoring the podcast.

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In terms of exercise, you know, here's again, it's a double edged sword. On the one hand, it's great to get exercise, but I'm familiar with, you know, if I train an hour a day, you know, 10 minutes of warm up in 50 minutes to an hour of weight training or 50 minutes to an hour of cardio, I feel great, especially if once a week I take a complete day off. That's sort of my general schedule. I'm also familiar with when I go out for runs that are excessively long, two hour runs, or I spend 90 minutes in the gym too frequently. I start to feel like garbage. Everything suffers. My sleep starts to suffer, it doesn't matter how much I eat, I don't seem to recover, I don't feel well.

So I realized that recovery ability varies between individuals, but what do you think is a healthy, sustainable exercise regimen that anyone can follow that will also support their hormone status? For really vigorous exercise, around three to four times a week is very sustainable over a long period of time. On top of that, you could add in three or four more instances of less vigorous exercise. Okay, so for less vigorous, would you mean that you know, zone two cardio where you can hold a conversation, but beyond which you can't? And for more vigorous, you're thinking weight training or high intensity interval type training. Is that right?

Correct. You can also weight train and have some benefit, even at a low to moderate intensity. If you think about weight training where you have, and it's not necessarily related to the incidence of domes, which is delayed onset muscle soreness. But if you weight train lazy or easy from time to time, obviously you want to weight train very heavy from time to time as well because of more lean body mass growth. But if you weight train lighter, you're going to be able to do it more often, and it can still help with the hypertrophy of collagen, for example, intendence and ligaments.

college and for example, attendance and ligaments. So here again, like to perhaps drill into this notion of intensity and light weights because for me, some of the most brutal workouts I've ever done were in what I would consider a high repetition range, 15 to 50. Actually, I went up to Oregon to watch the International Track and Field Championships. We went by Cameron Haines's place, right? The Cameron Haines's place, right? The Cameron Haines. He and his trainer put us through a workout that was 25 to 50 repetitions per set and it was done in circuit and it was brutal.

It was light. I mean, those weights were nothing. In some cases, it was body weight, but the number of repetitions was brutal. When you say limiting intensity, are you talking about limiting the number of sets to failure? Are you talking about really being kind of a lazy bear in the gym? I like to do that for you until a long, long rest, that sort of thing. What are your thoughts on that as it relates to hormone optimization? So I'll just mention and then I'll let you answer.

I feel best overall when I'm training for 10 minute warmups and about 45 or 50 minutes of weight training, where I'm pretty lazy between sets, two to three minute rest, training somewhere in the six to 10 rep range, going to failure every once in a while, but mostly getting that sort of last rep before what I would think is failure, no four straps, that kind of thing. And then jogging on the other days, nice and easy. When I do that, I feel fantastic in all other dimensions of life. When I train more intensely than that, even with lightweight, so faster cadence and lower rest, I feel like garbage.

I get a headache, I'm kind of ornry. Everything suffers. So what are your thoughts on kind of defining a optimal exercise strategy for hormones? I've never measured my hormones in those two different contexts, but I have to imagine that it's cortisol-related. When they study the effect of exercise, specifically vigorous exercise,

one area that's been studied is vigorous exercise episodes lasting longer than an hour. And they usually track it by a rating of perceived exertion, which isn't perfect, and it's not extremely actionable, but it's helpful for clinical science. But the takeaway from that is basically, do not, it is not hormonally helpful to train, especially regularly train vigorously for longer than an hour. Okay, so I'm happy to hear that because it sounds like for most people that hour of work is really the threshold.

I think it's important for people to hear, especially males because I think with all of the incredible examples out there of people like Cam, like David Goggins, people who are training for very long periods of time, you know, and leaving aside all the issues of what people are doing in order to optimize the recovery, I think an hour a day of exercise is just a great program that most anyone can follow. And beyond an hour, you start running into challenges. And I, you know, the occasional 90 minute or two hour workout is no big deal. But if you start doing that more than once every two months, I think you're headed for But if you start doing that more than once every two

months, I think you're headed for trouble. Have you seen that in people's blood work and in their hormones? Do you ever see people that are just badly over trained because they're just training too hard and too often? Yes. When the blood work is particularly bad, they're often in a large caloric deficit as well. There's a synergistic effect between a caloric deficit, even if you're maintaining adequate protein intake, you might not be maintaining adequate iron intake or adequate vitamin D. And you're also just literally in a caloric deficit, perhaps low carbs as well, very low free testosterone. And they're simultaneously doing a lot of vigorous exercise.

Interesting. I often hear, and I'm starting to wonder whether or not some of the quicker-to-results nutrition tactics, things like dropping all carbohydrates, or the quicker-to-results exercise habits, like starting to do six day a week, really intense workouts, whether or not in the short run they work because they cause the cosmetic changes that people are seeking, but that they really undermine the overall goal, which is at least to me to have your hormones maybe not optimized to the, you know, 100%, but to always be aiming for 100% and be close to it at every stage of life. Consistency is key here. If you are not consistent, then the law diminishing

returns certainly applies. So 80 or 90% of the benefit over many, many months is far better than 100%. But only half the time. One thing that I found to be tremendously useful is to finish the workout while I still have energy to not take myself to exhaustion. And then I'm able to talk about the dopamine wave pool. I'm able to sort of ride that into the rest of the day, feeling great.

I sort of save or bank some of the vigor from the training to bring it into my work. But then again, I'm not an athlete. I get paid to think and to speak, not to not to lift weights or to run. Another component of that is the balance between your sympathetic, which is your fight or flight nervous system

and your parasympathetic, which is your rest or digest nervous system. There is an anecdote, which is likely true that many elite bodybuilders are very parasympathetic besides while they're lifting weights. You mean they're lazy and they like to eat a lot? Yeah. The lazy bear and the gym kind of phenomenon.

Absolutely. But that being said, after a very, very vigorous workout, for example, one where you're trained to failure, which bodybuilders and power lifters do all the time, you feel the tiredness or you feel the strain from that heavy sympathetic activity when you are lifting a heavy weight, and it can potentially affect

how you feel the rest of the day. So many people who have a job that is highly cognitive do not like to have an extremely vigorous workout in the morning, which is when a lot of people are able to have an extremely vigorous workout in the morning, which is when a lot of people are able to exercise. When I exercise early in the morning, that is before 9am, I have more energy all day long. If I do it mid-morning, I have experience more of an afternoon crash. There's probably some circadian biology in there. I've also noticed, and I've actually seen in my blood work that if I don't get out for a 45 minute jog, at least once a week,

all of my blood profiles suffer in direction that I don't want them to go. In particular, testosterone and estrogen move in directions that are not conducive to my goals. I'd like to talk about some of the approaches that people can use in order to optimize hormones. And these days, for better or for worse, I think for worse, younger guys are asking about and using testosterone replacement therapy, so called TRT. And I just want to frame this up by saying, there is no strict cutoff for what is TRT. There are plenty of people whose blood levels of testosterone estrogen are within the normal reference range and decide to start doing these things.

Of course, they can limit fertility. They're a bunch of issues. Even at non-quote-quote steroid performance enhancing dosages, I'd love to frame this up by first defining our terms because one of the challenges on the internet is people talk about TRT, then they'll talk about performance enhancing drugs. They'll talk about steroids. They're all steroids. I mean, testosterone esters

and are both steroid hormones. But what one considered replacement therapy versus what one considers performance enhancing is gonna depend, right? So here's my question. Why in the world? Why in the world? Would any male in his teens or 20s, or even 30s, whose blood levels of testosterone

and estrogen are at the appropriate levels, meaning within the normal reference range, why would they take exogenous testosterone, given all the negative effects on fertility, some of the challenges that it can present if the dosages aren't quite right, et cetera. Why would they do that? Certainly, if they are not being paid for a particular endeavor, like they're not making money, if they are playing a sport chance, they're not allowed to do that anyway. On the pan substance list. So to me, it just seems like a crazy idea. But then again, I'm of a generation that really hasn't thought about doing that stuff until people were in their 40s and 50s or even never. So is there ever a case for somebody in their 20s or 30s to take testosterone?

But if their blood levels are within the 300 to 900 nanograms per deciliter reference range. Not many cases, the reason for any performance in a Hintz performance enhancing drug, whether or not it is a steroid, synthetic, bioidentical or otherwise, it varies a lot. Some individuals do it only for cosmetic reasons, even if it can have deleterious effects on like the cosmetic appearance, for example, of your skin in a long run. But everyone has their different reason as far as when does the benefit outweigh the detriment, not very often if you're in your 20s, and certainly, probably almost hardly never. There's always rare cases like callmen syndrome and whatnot, but almost never if you're very young.

Okay, so for people in their 20s, 30s and beyond 40s, etc, whose testosterone and estrogen levels are at their appropriate ratios and within the normal reference range, and they feel pretty good, right? We talked about the atoms example. This sort of like feel pretty good is sort of code for libido energy recovery, et cetera, are feeling, you know, at least workable for their lifestyle. For those people, what can they do besides get great sleep, train, but not too hard or too often, et cetera, et cetera? What are some of the things in the realm of supplementation that can help them optimize their testosterone and estrogen

without suppressing their own endogenous production of testosterone and estrogen. Let's mention creatine as the first one. Creatine is interesting because it has multiple different effects. It helps with amino acid synthesis. It also helps with oxidative stress. It can also serve as the backup fuel tank for your mitochondria, so kind of holding backup ATP. And it does slightly increase total testosterone, and it also increases the conversion

of testosterone to dihydrotestosterone. So potentially it's especially useful in men in their, even their teenage years and their 20s. You mentioned the conversion of testosterone to dihydrogen testosterone, and there is mythology out there that creatine can increase hair loss. I'm guessing because there's at least one study showing that creatine can increase DHT. Dihydrogen testosterone and DHT is one of the primary hormones that can promote male pattern baldness. So the question therefore is, does creatine supplementation increase the rate of hair loss? Theoretically it can, but in each individual

preventing hair loss is a very poor reason to take creatine because it's not going to take you to a physiologic level. It's not going to you to a super physiologic level, it's not going to increase your androgens to an unnormal level of binding. So I feel like this, if that was a reason to not take creatine for hair loss, then that's for, sorry, you mean hair loss is not a reason to avoid taking creatine. Correct. Hair loss is not a reason to avoid taking creatine. Correct. Hair loss is not a reason to avoid taking creatine. Think of it as just bringing you to what you are naturally inclined to have.

If your conversion of testosterone to DHT is already high, then often creatine does not affect this. It just kind of resets your balance between testosterone being aromatized to estrogen or being 5 alpha-reduced DHT. So it's not going to speed up hair loss more than just naturally being a male does. So in some individuals, it will have no effect. In some individuals, for whatever reason,

they have almost no five alpha-reductase activity. It will return them to natural or normal. I see. Well, I take five grams a day of creatine monohydrate. I do it for the tissue volumizing effects, for exercise benefits, but also for the cognitive effects. I don't know if it's increasing my hair loss. I mean, I've got a little bit of sort of widow's peak type hair loss.

That's where it is for me. I suppose beard growth is associated with DHT2. Most of it is that right. What I learned, but then again, I haven't been into this literature in a long time, is that because of changes in the receptors that DHT causes hair growth on the face and hair loss on the head, is that right? Yes, and the amount and the sensitivity and density of those receptors is genetically determined. And is it true that if your mother's father was bald, that you will be bald in the same pattern and if that he wasn't, you won't?

That is a decent correlation. Part of the proposed mechanism of this, well, there's several genes and you can actually test your genes for hair loss. You do get a decent amount of them from your mother. The unique thing you get from your mother that she may have gotten from her father, that she got one of the copies from her father is your ex chromosome. And the Androgen receptor gene is on your ex chromosome. So all men got their Androgen receptor gene from their mother. It's on their ex chromosome, not on the Y chromosome. Correct. Interesting.

Even though all of the sort of, quote unquote, male promoting genes are on the Y chromosome, like malaria and inhibiting, et cetera. Interesting. Okay, so five grams a day of creatine for most people should be fine, beneficial for tissue vomizing, so strength, bringing water into the muscles, and for the cognitive effects and the clinical support of the creatine, I think is quite strong at the 5 gram per day dosage. What other sorts of supplements can people benefit from? We already talked about the omega's and making sure

that people are getting enough prebiotic fiber to support the gut microbiome and vitamin D. So what other supplement based tools can people consider? Another one we can loop in with creatine is betaene. Some people are non-responders to creatines. You can increase that to 10 grams, or you can use its cousin betaene to help with amino acid synthesis

and shunting of energy. Along with that, I would put L-carnitine, which is actually the smallest peptide hormone, it's just two amino acids that are put together. So it's a hormone. Interesting. I'm not challenging it. Peptides, yeah, I'm not challenging.

I would call it a peptide, more than a hormone. So I would not call it an elocarnatine a hormone. But I would call it dopamine hormone. Yeah, I could. Neurohormone. It's so hard to define things as transmers or hormones at some level. I agree. So, Elkharnitine, actually, I should backtrack betaine. Do you recall what dosage people

typically would take if they're a creatine non-responder? One to three grams. In fact, several versions of creatine have betaine mixed in because it helps with the processing of methionine and homocysteine. So if somebody is already taking creatine and likes it and responds to it, I'll raise my hand, such as myself, would adding betaene help or is it redundant with creatine? Only if their homocysteine is persistently elevated. And homocysteine is kind of like an inflammatory marker that can build up if you're not converting enough of it down the stream.

How would I know? Just a blood test. Okay. Or if you knew your MTHFR polymorphism, which is basically how you add methyl groups to many things in the body. Great. Any side effects of betaene that people should be aware of?

Not that I know of. Okay. People can look it up on examine.com's a great site for that. They'll surely list it. They just revamped their site by the way and it was awesome before and it's platinum now. So Elkharnitine, what are the ways to take Elkharnitine? I know that there is an oral form, so capsules and there is injectables.

The injectables, I think you need a prescription, is that right? Correct. You need a prescription for the injectables or you. You need a prescription for the injectables, or you should really get a prescription for the injectables. When you inject it, of course, at the supervision of your doctor, it's usually done intramuscularly. It's an aqueous solution, so it does not have an oil or a carrier oil in it,

like testosterone, esters do. However, if you inject it too superficially, it's not going to make it rake anything off, and it just burns if you inject it subcutaneously. And it does not disseminate throughout the body as well. Elkharnitine potentially has localized effects if you inject it, if you ingest it orally, then it has a very low bioavailability, maybe only 10%. Well, I think most people are going to be able to get Elkharnitine only, or, you know, in its capsule form. So what are the doses of Elkharnitine that one needs to ingest, then if they want to

get a benefit because if only 10% is being absorbed, it's probably a lot of Elkharnitine. How much should people take per day? Usually I recommend for oral Elkharnitine between 1,000 milligrams and up to 4,000 or 5,000 milligrams. So 1 to 4, maybe even 5 grams. Correct. Up to 5 grams a day. If you're on that much, especially if you have a dysregulated gut microbiome, you should

be concerned with TMAO, which is a potential carcinogen that both carnitine and coolean can convert into. And your gut microbiota determine how much that happens. Is it true that I can offset any negative effects of alpha GPC coolean that is NL carnitine that I take by ingesting garlic? Is that right? There's a compound in garlic called Alicin. I believe it's ALLICIN. It's also part of the scientific name, the genus of types of garlic. And this can help decrease

the conversion to TMAO. Burberrying actually slightly decreases the conversion to TMAO as well, probably through alteration of the gut microbiome. And then just optimizing your gut microbiome can decrease conversion. So not everyone needs Alicin, but it's something that you should certainly consider if you

were on a high dose. I'm going to continue to take the 600 milligrams of garlic every time I take my alcharnatine, but I'm going to skip the burbring because burbring gives me brutal headaches and it makes me crave carbohydrates because it drops my blood sugar. It has many other effects, including the dawn phenomenon, where it drops your blood sugar when you're sleeping and you can't even realize it. I am not a fan of burbring and I'm sorry for those of you that are, I'm not trying to offend anyone, although frankly, if you're being offended by my stance on burbring, then maybe we should

have another discussion. In any case, injectable alcohol and teen if one can get that through a doctor, how much is doctor, how much is absorbed and how much should one take? Almost all of it's absorbed. In general, you're taking between 500 milligrams up to, you can take a pretty high dose up to 2000 milligrams. Okay. And what we did not talk about is what alchornitine does.

So why should someone go through all of this? Is it to optimize testosterone? Is it working on the receptor side? What's Elkhana team doing? It's a shuttle. So I think it's named Carnitine Palmatial Coenzyme A. Basically, it just takes nutrients from outside your mitochondria and puts them in. It also has a unique effect. Well well not too unique because Tidalophil actually has this effect as well, is that it increases the density of the Androgen receptor and the cytoplasm of your cells. So even if your Androgen receptor sensitivity doesn't change and even if your testosterone does not change, you will have more testosterone binding to that increased number of receptors. Does one need to cycle outarnitine, creatine, betaene?

No reason to cycle any of those. Okay, what other supplements can one use to try and improve hormone profiles? And here I realize we're using a very broad brush because when we say improve hormone profiles, what are we really talking about? And for me at least I think about the subjective stuff. You know, do people feel like they are going to have more energy as a consequence of doing these things?

Are they going to have the more optimized libido? Are they going to have more optimized recovery from exercise? Right? Because I mean, it's not clear to me that taking one testosterone from 600 to 800 is always going to be a good thing, especially if estrogen is increasing in parallel that could cause issues, it could certainly make things better, it could certainly make things worse. Right? So with that backdrop, what are some of the other things

people can take, and then we'll go back to this issue of what really is optimization? Let's briefly mention vitamin D, which is also a hormone. It's actually a sterile hormone. And if you have deficient vitamin D and you replace it, then you will optimize your testosterone. It's also mentioned boron. So if you have a very high SHBG, boron can it cutely help lower it?

Usually in a dose of five to 12 milligrams per day. It's not really a sustained effect, but boron is depleted in soils in many countries. I believe it's very high in soils in Greece and Turkey. So eating dates or raisins that are from those areas, potentially have more boron. Boron also might be one of the reasons why the reference range for testosterone is much higher in those countries than other countries. And just to remind people, the SHBG-6 hormone mining globulin is attaching to the testosterone molecule and limiting the amount of so-called

free testosterone that's available to have its impact on cells. Dr. Peter Atio was on this podcast, in fact sitting in that very chair. He said that the ideal level of free testosterone in male should be about 2% of one's total testosterone. Would you agree with that number or disagree? I'm sure Peter would be fine if you said either. 2% is a good rule of thumb. Usually the reference range is between about 1% and 4%.

Some people do have genetic polymorphisms in SHBG, a specific gene mutation where they have very low SHBGs. Also men that have varicose veins in their testes, also known as varicose seals, tend to have very high SHBGs, so that percentage would likely be less than 2%. So just because your percentage of free tea to total tea is a little bit above or below 2%, that's okay. We just need to figure out the reason why it is. How would somebody know if they have varicose veins in their testicles, especially if their testicles are still attached to their body?

Sometimes it's hard to tell. There is several grades. If you have a grade three or a grade four test varicoseal, it has what's called a bag of worms appearance. So think about if you've just resistance trained or it's a really hot day or you're wearing very tight fitting clothing, then if you feel it and almost feels like there's worms in the scrotum, the other way is to do... So scary visual.

Yeah, bag of worms. Well, just that, yeah, anyway, I think parasites when I hear that, but that's not what you're referring to. You're talking about just the texture. The best way for most people to check is to valve salva for a long period of time. When you valve salva, venous return will decrease. Can you explain valve salva for people?

It's bearing down like you're lifting a weight or having a bowel movement. Where you swallow and a lot of times you can almost see build up of blood in your like jugular veins as well. So you have increased blood return to the heart and increased blood in the veins themselves. Okay, so vitamin D3, I'm guessing you're talking about vitamin D3 specifically when you say vitamin D, and then boron 5 to 12 milligrams per day. And then what are some of the other things to optimize testosterone that are in supplement 4? We can talk about things that affect the stereotogenesis cascade, so we could touch on

Tonk et al. I know we've talked about that a little bit before, so I'm guessing a number of people probably haven't heard that conversation. Also known as longjack, and that upregulates several different enzymes in this droidogenesis cascade. And by that, what you mean, if, and this is another good thing to Google, I think anybody interested in hormone optimization should understand where sterile hormones come from.

They come usually from cholesterol, and they can be shunted off to vitamin D very easily. They can be shunted off to testosterone or estrogen or progesterogens quite easily as well. But Toncat helps with the conversion of multiple key steps where you synthesize testosterone. Another, I think of it as like a co-inzymer, a co-factor, an up-regulator of these steps is insulin and IGF1.

So a good rule of thumb is if you are not expecting as much growth hormone insulin and IGF1, for example, lower carb diets, caloric deficits, you're trying to cut body fat or body weight, then Toncat is going to be theoretically especially powerful. What sorts of dosages of Toncat do you recommend to your patients? Anywhere from 300 to 1200 milligrams a day, with Toncat, you

need to be careful with the standardization because, and if you're thinking about a general Toncat supplement, which is by far the most well studied, then you're looking at the urecommonone content, which is a plant compound that is likely the main active pharmacologic effect. So that's the compound that's having the effect on the body. And if you standardize the urecommonone very, very high, then theoretically you're having more effects at a lower dose. I take 400 milligrams of Tonga Ali per day. I take it early in the day because it has a

bit of a stimulant effect. And if I take it after 2 pm, it starts to inhibit my sleep. I've been taking it for years. And I rather like that the effects that it seems subtle, but you know, consistent. I've never cycled it. Do you recommend cycling it? I don't see any reason to cycle it. There is, there is a reason to cycle some supplements, but no reason to cycle. Tonka. My blood work tells me that it causes an increase in free testosterone for me and also a slight increase in luteinizing hormone for me and also a slight increase in luteinizing hormone for me. What are some of the other effects on various hormones that you've

observed in the blood work of your patients taking Tonga Ali? Toncat can also slightly increase DHEA. And if you have a very high SHBG, again, that's the protein that binds up your androgens and estrogens, an extremely important protein. The higher your SHBG, the more it helps decrease it. So they've studied Tongcat in populations with very normal SHBG's, and it does nothing for SHBG. Interesting. Does that mean it does nothing for somebody overall? So if somebody has SHBG that's in the normal range, we're taking Tongcat benefit them in any other way.

Yes, it'll increase their total and free testosterone. Got it. Okay, is it known to have effects on anything else, like thyroid hormone, growth hormone, or is it purely in these steroid synthesis pathways? Or steroid, I should say, synthesis and receptor and modulation pathways. There's no direct effect on those pathways. Or steroid, I should say, synthesis and receptor and modulation pathways. There's no direct effect on those pathways. However, anytime you alter your free androgen or free

estrogen, particularly one without altering the other, it will alter the binding protein that binds thyroid hormones. So any change you make, whether it's natural optimization or hormone replacement, you're going to slightly skew your thyroid hormone profile. One common, like actionable example of this that I see often clinically is someone starts, let's say estrogen replacement or testosterone replacement, maybe they're taking AI with their testosterone replacement. At Romantic inhibitor. Correct, and a rheumatase inhibitor, which blocks the conversion to estrogen. If they're taking testosterone and they have very little estrogen, then you're going to decrease the binding protein, also known as thyroxine binding

globulin, which binds active thyroid hormones. So if you start TRT and you either have low aromatics activity or no aromatics activity, no conversion to estrogen, then your free thyroid hormones will go up even just acutely, usually feedback inhibition, which is how the body talks to itself and says, you know, we need to make more of this or less of this. But acutely, there's not always enough time. You're going to have very high thyroid hormones and you can have tachycardia, which is a fast heart rate or you can feel kind of like overly fight or flight due

to increased thyroid hormone activity in the end tissue. Interesting. Okay, so Tonga Ali, this is a broad range, 300 to 1200 milligrams per day and I realized that the source matters there. What are some of the other hormones that you prescribe to your patients who do not want to go on testosterone replacement therapy or take exogenous DHA or anything like that?

We can talk about Fadoja next. Fadoja is interesting because it's a genus of plants. Fodosia aggressus is one of them. There's many others that are very interesting. That species is likely the most well studied and it will increase LH. So I would not consider it an LH mimetic. So it doesn't really mimic it, but it increases the release of luteinizing hormone from the pituitary. That's a hormone that binds to the latex cell, to the elitre receptor, kind of like HCG does, and it will increase the release of testosterone. I see. So I think for people who aren't familiar with HCG, so human Chorionic Ganatotropin is basically synthetic luteinizing hormone. And luteinizing hormone is the hormone released from the pituitary that is going to travel down to the testes to stimulate the production of sperm and testosterone, but mainly testosterone.

Is that correct? Mostly correct. Technically synthetic LH is also known as little RLH or recombinant LH. And HCG can be synthetic, but often it is just refined from the urine of pregnant ladies since the, since the placenta makes it. That's why it's called Chorionic, Gennadotropin. So where are they getting all this pregnant women's urine? I mean, there's there a location, not that I want to go there. Donation. Yeah.

Really, so they're women that send... First try, I muster pregnant ladies, it's very high. Donating their urine, and then they're purifying it, and then men are injecting it. Yes. Wow. And that's actually the same for menopausal ladies. So first trimester pregnant ladies, that's how you can make non-synthetic HCG. And then for minotropins, which are also known, there's a couple of different names for it,

like minopure, you have minopausal ladies that have very high LH and FSH, and then you refine the FSH and LH. Okay, so moving away from the sources and from urine, Fodogia agressis, what dosages do you have? Patients take, I've heard of some potential toxicity to the testicular cells? There is one study, and this is a rat study, but you can equate the dose of toxicity

in rats and humans. They did not give these rats any antioxidants, but it increases a couple different, like pro-inflammatory markers. One is GGT or Gamma-Glutamil transferase, comes from both the testes and the liver, and one is alkaline phosphatase, also known as alkyphosph, again coming from both areas. There are several different ways

that you can attenuate this increase, and you can also just check to see if you have increased in the rat dose that equates with humans that had no effect, so the safe dose was an average of 300 milligrams a day. So that would be 300 milligrams a day in humans is the dosage that did not have toxicity, correct? Correct.

And often, even if there is toxicity in rats, there is not toxicity in humans. So it's not directly equitable. But to be safe, another regimen that I have people take is 600 milligrams every other day or 600 milligrams three times a week, often Monday, Wednesday, Friday. This is very interesting and relevant because I've been taking Fidojiya for some period of time. All my markers and tests indicate that there's no toxicity, but I've been taking 600 milligrams per day, but I've been cycling it

for about eight to 12 weeks on and then a few weeks off. But basically, what you're saying, I'm thinking maybe three times per week or every other day might be better, is that right? If you weren't going to get any labs, that is certainly the regimen that you want. If you're going to check your GGT and alkyphos, or even take other things to prevent those from increasing, then you can certainly be more aggressive with your fidocha dosing. You can increase it quite a bit, and it has a dose-dependent response in both the activities associated with high testosterone and also just LH and testosterone. So the more aggressive regimen would be 600 milligrams daily for a month and then take one to two weeks off. Great. I think that's more or less what I've been doing.

Okay, terrific. In terms of other hormones, what are some of the supplements they can support growth hormone? I had a hormone that's associated with tissue repair and in some cases metabolism and fat loss. What are some of the tools nutritional and or supplement based one can do to tap on the growth hormone pathway and let's lump IGF1 in there too since they're essentially working along the same dimensions. A quick synopsis growth hormone is a peptide hormone and it is released by the pituitary. There's growth hormone releasing hormone and a ghrelin that stimulate the release.

So there's also peptides that are very analogous to these two things. You have that pulsatile secretion of growth hormone in a very fast half-life of just minutes, and then it increases IGF1. There is both peripheral IGF1 and central IGF1 and IGF2, but no need to get into the specifics. There is a happy medium to where your growth hormone is at a adequate level, and your IGF1 is

an adequate level. Usually, those two are congruent. So in most cases, we just check an IGF1, and occasionally the binding peptides for IGF1, kind of like SHBG that we talked about earlier, but you're estimating a free IGF1. It's kind of confusing because all hormone, almost all hormones have binding proteins to help regulate them, but often you want to look at free testosterone, free estradiol, free IGF1, or at least estimate it, free cortisol even and free thyroid hormone. But when you're talking about growth hormone and IGF1, usually you don't need to do anything to optimize it. If you are diabetic, then depending on the type of diabetes, your IGF1 and growth hormone

can be too high. Specifically in type 1 diabetes, your growth hormone is extremely high, but your IGF1 and growth hormone can be too high. Specifically in type one diabetes, your growth hormone is extremely high, but your IGF1 is low. So if you're in a dysregulated state or have pathology, I would just talk to your doctor about IGF1 or growth hormone, taking amino acids before you go to bed could potentially help with growth hormone release

just because most growth hormone is released while you sleep. I've heard that fast ink can increase growth hormone release, just because most growth hormone is released while you sleep. I've heard that fast income increase growth hormone, and I know there are certain patterns of weight training that can increase growth hormone. Some of those regimens in the weight room that increase growth hormone have been covered by Dr. Duncan French, who is a guest on this podcast. So maybe we'll refer people to that episode for the specific protocols, these high volume training. During those training exercises, it usually does it transiently for a period of a few hours. And a lot of this IGF1 is released by the muscle itself.

So it's not necessarily released by the liver. IGF1 that is released directly due to growth hormone signaling, usually the growth hormone comes from the pituitary and binds to the liver, where it usually has a half-life of about a week, where the paracrine or autocrine think of it as like the peripherally acting or acting in the muscles itself, which is also helpful, is released and is not as concerning because it's not related to insulin resistance, but it is related to the training itself.

So fasting and growth hormone, is it true that fasting can increase growth hormone? And maybe as a little related tangent, I've heard that limiting food intake for the two hours before going to sleep can increase the pulse of growth hormone that one experiences during sleep. Of course, everyone gets a pulse of growth hormone during sleep, but especially carbohydrate-laden meals can blunt that peak that occurs during sleep quite substantially. So two questions. Does avoiding food intake in the two hours prior to sleep help increase

growth hormone release? Maybe it's being overly neurotic, maybe people need to avoid food in the four hours before sleep. But regardless, what is the relationship between fasting and growth hormone release? I find this really interesting. Fasting certainly, potently increases growth hormone release. However, the end binding to the receptor is less sensitive. So, although fasting does increase growth hormone, the genes that are downstream to it, both the growth hormone genes and IGF-1 related gene transcription activity will not be significantly higher. transcription activity will not be significantly higher. However, if you are optimizing the growth hormone that is released as a pulsatile secretion, it is helpful to avoid eating for two hours. So the general thumb is avoid eating about two hours before bed. I think that's clinically

significant and helpful, but fasting otherwise specifically for growth hormone optimization and someone who already has normal growth hormone signaling is not helpful. That's extremely useful to hear because one of the major reasons why people fast is to get that growth hormone increase, but if they're adjusting things on the back end that negate that, well, then no such luck. Not that I have anything against fasting. I do a pseudo intermittent fasting mostly because I prefer to eat it fairly regular times of day. Okay, so it doesn't sound like there's a lot

that people can take in supplement form to improve growth hormone. What about thyroid hormone? What are some of the things that people can take or do in order to make sure that their thyroid hormone levels are appropriate? You want to have a balance of iodine and you want to have a good source of iodine. So there's some camps that say you should use a huge high dose of iodine, and there's

protocols for it, and there's some that say you should use just barely enough iodine. I believe it's like 200 micrograms per day. But you want to balance one of the things that I see that many people do not talk about when it comes to iodine and thyroid is there is compounds known as goitrogens or goitrogens. And these goitrogens are neither good nor evil, but they're actually kind of a nice check in balance. You need more iodine if you consume more goitrogens. And some examples of these are some of my favorite fruit, foods cruciferous vegetables, boron is also a gochurchin. So higher gochurchins, higher iodine.

So adjusting iodine containing salt is useful? Yes or no? Iodized salt does prevent goiter, but it is not necessarily the ideal form of iodine. Good forms of iodine often come from the ocean. If you look at a chart of hypothyroidism, there is a tendency to have more hypothyroidism the more inland you go. So trying to eat some cruciferous vegetables each day would be the best way to improve thyroid armor. Along with plenty of iodine, you don't want too much iodine signaling. Many people are familiar

with radioactive iodine tablets, and that's basically an extremely high amount of iodine to block out the radioactive iodine that comes from after a nuclear meltdown or whatnot. So we've got creatine, bitting, elkarnitine, with Allison, garlic, to offset the TMAO vitamin D3, boron, tonga, alifadogia, some fasting. I love to talk to you about peptides. So I can imagine a hierarchy. The hierarchy starts with behaviors and nutrition. Behaviors, of course, includes training and limiting stress and all the things we talked about before, sunshine, et cetera, and optimize nutrition. Then we talked about supplements, all the things we just listed off to optimize testosterone.

And we can get into this, but estrogen as well, which is important for libido and brain function and tissue function and joint feeling good, et cetera. But then we get into the realm where one might or could consider exogenous hormones, taking a small dose of testosterone or taking a small dose of GH even if that were appropriate and certainly only working with a doctor. But in between, there's a step of so-called peptides. And of course, there are many peptides we've already talked about some of them. But when people talk about taking peptides,

the ones that I hear most often about is a category that increases GH and IGF1 and those to my knowledge go by the thing, it's like Sermore Ellen, hypermorellen, Tessamorellen, sort of a kit of things that take in separately or in combination to increase GH and IGF1. But then other people, for instance, are taking peptides like BPC157 to try and improve

tissue healing and recovery. There's a lot of interest in peptides. Please, if you would, tell us about what you know about the safety of peptides in terms of their sourcing and the utility of peptides. You know, is this something that people should consider before thinking about hormone replacement? Should people be wary of these things? I am very, wary of particular sources that are sold online that are not clean. They contain contaminants and that could be dangerous.

I really would love your thoughts on peptides. I'm just going to sit back and let you riff on peptides. But if you could touch on some of the ones that I mentioned, I'd be most grateful. A peptide is just a chain of amino acids between two and a couple hundred in length. So I think of peptides as several different categories. And the GHRPs that you mentioned,

I would consider those, and that stands for growth hormone releasing peptide. You have two main types, the grellin agonist, or they hit the grellin receptor, and it helps release growth hormone because of that. And then also the GHRH-like peptides. So they're very similar to growth hormone releasing hormone. Often they just change a couple amino acids and it acts like that. Tessa Morlin is one of them. Cermorlin is another one and CJC is another common one.

I believe those are all in the class of GHRH-like peptides, whereas Ipomerrelin or Ibutymorin, which is also known as MK677, those two are in the class of grellen agonist. So they're more like, they hit the receptor that grellen does, or as the other ones hit the GH or H receptor. I think if grellen is making me hungry, hungry and angry,

why would I want to take something that would increase grellen, or signaling? Some people are trying to gain weight. It also does increase your growth hormone. So if your growth hormone is very low, you can consider it. I butamorin is a long acting. So as a long half life, also known as MK677, it was well, it was studied mostly in growth hormone deficiency. And do these people get angry also? They can, many people report a side effect of anxiety or significant hunger. Most people take it in the evening so they don't notice that hunger as much.

It can also greatly increase your blood glucose. So if you're insulin resistant or prediabetic, it gets especially concerning. This is one of those rare moments where I hear something and I think, okay, even though there's this kit of compounds that can increase GH and IGF1, based on everything you're telling me, maybe just taking GH is the better option for those people. Because growth hormone, at least it's synthetic growth hormone is mimicking an endogenous hormone. I mean, certainly not taking anything that might be the ideal, but for those that want to increase growth hormone and they want to use pharmacology to do that, some of these peptides are

pretty precarious. Yeah, it kind of depends on the situation. If there's an individual that struggles with hunger and not eating it enough, for example, you know, someone who has a very small stomach or they just have a very low hunger drive, sometimes you want more of that a rexigenic signaling, the hypothalamus, you have anorexigenic signaling, which is kind of like anorexia, an orexigenic signaling,

which is I call it the hangry center of the hypothalamus or the hangry center. And if there's an imbalance between those two, then perhaps it'd be helpful. Potentially theoretically helpful in anorexics of which the incidence of anorexia and men is increasing significantly. As you're telling me this, I'm remembering being 14 or 15 years old, and I would go into the kitchen sometimes, and I was so hungry, I would just obliterate all the food. And I do remember being,

I've always been pretty high energy guy, but having an immense amount of energy, I can't recall if it was a hangry feeling or not, but I'm guessing that was growth hormone. I grew one foot in a single academic year. So I'm imagine that was at least in part due to growth hormone. In any case, summer relin is the peptide that I hear that most often about.

I admittedly tried a run of it. I was researching a book and decided to take it before sleep on an empty stomach. It gave me a tremendous depth of sleep. But that sleep was really truncated, which is just nerdspeak for saying, deep, but short sleep, I would wake up after very intense dreams. I can't say that it helped me recover from exercise that much. I didn't notice any additional fat loss or anything sort of abandoned it, except for occasional use.

Again, this was prescribed by a doctor. I was trying to get the sense that these peptides in their effects are somewhat vague and distributed and highly individual. Is that a fair way to describe them? Part of the problem with the effective peptides is many people take them in levels that are far above the physiologic range. Even individuals who are checking their IGF1 while they take these different GHRPs,

most of them do not check the binding peptides. For example, IGF binding peptide 1, 2, or 3. And their free IGF1 level might be significantly different. So the common doses that people will take these off label for as a supplement are often much greater than the therapeutic or physiologic range. Which for me just underscores the fact that it's pretty precarious. I mean, I'm not coming are often much greater than the therapeutic or physiologic range. Which for me just underscores the fact that it's pretty precarious. I mean, I'm not coming in here as the referee

of what anyone should or shouldn't do. It's trying to gather and distribute information, but I've heard, for instance, that some companies where people can acquire these things without prescription, those companies are not good at cleaning out the Lippie-Polly Saccharide, the LPS, which can cause an inflammatory response. In other words, these are dirty compounds.

And that just sounds risky. It just sounds, frankly, it just sounds really dangerous to me. LPS is a common additive in many companies that are not pharmacies, but they're selling things that people often use as human consumption. One interesting note about lipopolysaccharide is your gut microbiome actually makes a lot of it as well, especially previtella, which is a specific species that can have to do with your baseline body temperature. So your baseline body temperature might also change depending on if you're on a peptide that has LPS in it.

Yikes, yikes, and yikes. But I tend to be pretty conservative when it comes to taking anything exogenous. But I do rely on many of the supplements that we talked about earlier, and I do try and optimize the behavioral things and nutritional things for a long time. Okay, so then leaving peptides behind, we are now, I suppose, in the territory of exogenous hormone. So let's say that somebody decides, they're not concerned with fertility

or they're gonna bank sperm or they already have kids or they're going to defer on this issue of one and a half kids. My understanding is that nowadays, a lot of people are using testosterone. It's not even called replacement therapy because some of these people have 600, 700 or even 800 ng per deciliter reads. So they're not replacing anything that is diminished. They're just trying to augment what's already there, increase what's already there. My understanding is

that taking a low dose more frequently is going to be more beneficial than the kind of old school way of giving, you know, 100 or even 200 milligrams in a single injection once every two weeks. Is that right? And what do you do with your patients? So let me give you a hypothetical. Somebody comes into your office, they're blood work and they have blood levels of, let's say, 600 nanograms per desolary or testosterone. Their estrogen is also in normal range. Everything else checks out, but they're complaining of slightly diminishing libido, slightly

poor recovery from workout. It's maybe reduce motivation and drive, although no major depression. You come to the conclusion that testosterone therapy, not replacement, but testosterone therapy, might be a good option to explore. What's a typical dosage range and frequency of administration range that you might consider exploring? Some of this depends on the SHBG and free testosterone as well. So if that same individual had a very high SHBG, which again is the binding protein that binds up the testosterone and all Androgens and Estrogens. If it is extremely high and they have a free testosterone of two, then they might need

a different dose because they need enough testosterone in order to have a normal eugenadal free testosterone. But a general normal dosing range, especially for someone starting, is around 100 to 120 milligrams divided over the course of a week, usually either every other day or three times a week, occasionally twice a week. Many people with SHBG a bit higher can get away pretty easily with twice a week. This is assuming that the ester is sippianate or an antate. So, 260 milligram injections of testosterone sippianate per week.

Yeah, very common dosing. To hit that 120 milligrams per week is kind of the typical average. Correct. And I would consider this a like a physiologic eugenadil dose. For many people, even 200 milligrams a week is far above the reference range. All of this is said with the caveat that testosterone is normally released in a pulsatile manner. So it's high in the morning, low in the evening. Whereas if you're on testosterone therapy, then you're going to have a steady state.

So your testosterone level is going to be pretty much the same even in the evening. And in your experience, when patients do that, I'm guessing they report the normal constellation of positive effects, improved mood, improved energy, improved sleep, recovery, etc. What are some of the hazards or things that can crop up in blood work or just subjectively that can be warning signs that even a dosage of 120 milligrams divided into these two or three dosages per week is too high? Every organ system in the body. This is when you really have to be at least well versed in every organ system, not just

the genital system. You need to have dermatology prowess. Acne is a very common change. Lots of different skin pathologies or even bruising can be related to hormone replacement. Hair loss is very common to see as well. Mental status changes, it could occasionally even induce a manic or bipolar episode

because testosterone is also dopaminergic. And then cardiovascularly, not just in the heart, but also concerns for like microvascular ischemic disease, ferrets in buildup because the estrogen also increases and then fertility concerns as well and lipid concerns too. So you really have to be, you know, hematologist, dermatologist, cardiologist, lipidologist, the whole nine yards. So another reason or set of reasons rather to, if one is considering using testosterone therapy

to really do this in close communication with a really good physician, because that's a lot to monitor. Knowing whether or not you have acne or not is one thing, but knowing whether or not your LDL is going up your apobie is going up, that's a whole other biz and that needs to be done through blood work

is what I'm hearing. Correct. And if your physician that is managing or prescribing your testosterone therapy or your HRT is not well versed in these systems, you would want him or her to be part of an interdisciplinary team where they have other experts that can monitor those systems. I skipped over sort of still intermediate set of things, prescription drugs, but maybe talking about testosterone first was a bit of a mistake on my part because I'm aware that they're actually, I think they're companies, but certainly groups out there that say, no, wait, don't go straight from nothing to supplements to testosterone. Once you're doing behaviors and optimizing nutrition supplements,

let's forget peptides. Instead of going straight to testosterone therapy, one idea that many people are pursuing is to take the prescription drugs that trigger luteinizing hormones, so taking HCG, human-chorionic gonatotropin, which my understanding is we'll increase testosterone, but also estrogen, or they'll take things like clomophine. In fact, I think there are a bunch of companies out there now that are saying, don't take testosterone. It shuts down spermatogenesis, shuts down testosterone production.

Clomophine is the way to go. Maybe you could educate us about the HCG monotherapy. I think it's called where you're just mono, one just taking HCG and clomophin as a and or clomophin as a tool to ratchet up hormones. So quick points on HCG human Chorianic and Atropin made during especially the first trimester of pregnancy. It has effects other than binding to the LH receptor. It also binds to the TSH receptor and the thyroid.

It's thyroid-simulating hormone. Yes. In fact, if you look at a molecule of HCG and thyroid-simulating hormone, they are extremely similar. However, you need a relatively high dose of HCG to bind to the TSH receptor. This is the normal mechanism in pregnancy that accounts for the increased need of thyroid hormone, usually about 30 to 40%. So that's why if someone has hypothyroidism, you need to increase theridose thyroid because the HCG is not going to be doing it for you. The clomid or clomifen, there's two main, I believe it's di-stereoisomers, And one of them is inclomifin, one of them is zoo-clomifin. And these two work slightly differently. Inclomifin, I believe, has a faster half-life.

And it is potentially slightly better tolerated. However, they were studying it. Clomid is a very commonly prescribed drug. And obviously, there's plenty of incclometh and in clomid. However, the drug, which was and result, A and DRO X-HL, did not go all the way through the FDA approval process, despite clomid being FDA approved. Okay. So there's clomid, which contains clomifin. But there are also, because we're talking about male hormone optimization this episode, there are males out there who want to increase their testosterone and other hormones,

maybe growth hormone, etc. who opt to not take exogenous testosterone. So no cream, no pellet, no no pill, no injectable supianate, but decide to take clomophin a couple of times a week. My understanding, I've never done this, I would say if I had, my understanding is that taking clomophine, maybe two, 15 milligram tablets a week is what I hear people are doing, will increase what? Lutinizing hormone, the various estrogen receptor subunits, could you explain how clomophine would benefit anyone? And is this a good strategy? I'm hearing that it's being done quite a lot now.

It will increase testosterone in a dose-dependent manner, but it has many other pharmacodynamic effects, which is the effect of the drug on the body, other than its effect on the hypothalamus and the pituitary. So in the hypothalamus and the pituitary, it does what's called negative feedback inhibition, or it blocks the axed gen of estrogen. So it crowds out estrogen from the estrogen receptor on the hypothalamus in the buttoetary. And what's the subjective effect that that would cause? So my understanding and experience of estrogen

is that if I ever took, and I did take a very low dose of an aromatase inhibitor once and I felt terrible. Actually, reduced libido, joints fell achy. That's when I discovered that, wow, estrogen is actually really important for your brain function, for joint function, and for libido. And suppressing estrogen for me turned out to be just the wrong idea. But my level is indicate that it's within reference range. Okay.

So, why would I want to take something that would increase the activity of an estrogen receptor? I just can't find the rationale for that. The main rationale behind taking a SIRM is as a very temporary measure that is not going to suppress pituitary or hypothalamic function. If your testosterone is just so drastically low that it is unlikely to recover anyway. So most of the time, it is not clinically useful and serms should not be prescribed very often, certainly not as long-term testosterone replacement or testosterone optimization in most individuals. There's always exceptions to everything, but there's five different estrogen

and estrogen related receptors. There's two main estrogen receptors in clomid and every serum has a very unique profile because they selectively inhibit some receptors in some tissues, but not other receptors in other tissues. For example, clomid can inhibit receptors that are in the eye, and it can cause visual changes, blurry vision, especially at higher doses. And it also acts in every other tissue of the body.

So side effects from clomid and other selective estrogen receptor modifiers are very common. So, I'm at least by my mind, I'm going to pull them with peptides and say it sounds precarious, and probably not ideal for most people. Going back to testosterone therapy, then, I get to notice folks have deleted the replacement part, because I think so many people are using testosterone therapy without the need to, the sort of reference range need to, to replace anything, but rather building on what they already have for purposes of increasing vitality, et cetera. Going back to that, my understanding is that taking HCG several times per week can help maintain spermage, antigen genesis and fertility, even while people are on testosterone.

But, and you know what I were talking about this earlier, that there's tremendous variation. Some people will take a small amount testosterone and just crush their sperm count. They just won't make any viable sperm. Other people can maintain viable sperm production while on testosterone, especially if they're taking H.C.G. Is that right? Correct. And there's many reasons for this.

Some of this has to do with heat damage to the testes. So potentially, cold therapy could be helpful for that. Ice baths, cold showers. Or just a, and certainly avoiding sauna hot tub. Yeah. Stopping the daily hot tub can restore fertility and many people. I know a number of people that are trying to

can see children that go into the sauna and they'll just put a cold pack in their shorts or between their legs, depending on whether or not the wearing shorts are not where they go in, or they'll alternate ice and heat in a way that maintains coolness of the milieu in which the sperm live. In other words, they're cooling their scrotum deliberately

in order to avoid killing the sperm. Actually, it's an interesting paper that said that for every two degree increase in temperature of the scrotum, there's a 20% decrease in sperm adegenticins and viability of sperm. And then actually, if you look at the difference between people who stand a lot, sit a lot, and drive a lot, what you see is a progressive decrease in sperm count. That because when people are sitting, there's an increase

in temperature. And then when they're sitting on the hot seat of the car, there's an, or using the heated seats, actually kills sperm. I think they're good data on that. Yeah, excellent data. And anecdotally, you see it as well. I've had several patients come in for fertility consultations. And all we do is, you know, no medications, no supplements, we change their, like, several lifestyle things. A tight fit, very tight fitting clothing is another one. And soon they have fertility. And they're no longer, they have sperm, whereas before they did not. Interesting. I'd like to talk about some of the do's and don'ts, but we have talked about a lot of do's, things that one can do to optimize hormones. Maybe we could just do a sort of more rapid fire,

Q&A on some of the don'ts and maybe throw in some science where you feel it's appropriate. Cannabis marijuana, THC, yes or no, it diminishes testosterone levels. Smoked cannabis, I would say, diminishes testosterone, increases prolactin that's a no. Other cannabinoids, not particularly harmful. So CBD, not particularly harmful, smoked CBD, I'm not sure. What about edible cannabis and THC? As far as I know, edible cannabis and THC does not significantly increase prolactin to a point where it would be disruptive of hormones. Can marijuana, THC, cannabis, whatever you wanna call it,

increase gynecumastia, the growth of male breast tissue? Yes, it certainly can. And there's a pretty good association between smoked THC and gynecumastia. What about nicotine and testosterone and estrogen and other hormones, smoked nicotine? Nicotine is particularly concerning not only for testosterone, but also for estrogen. Part of it is if you're talking about nicotine from tobacco, there's many other carcinogens

in it, especially if it's smoked, but nicotine, even if it is chewed in a dose-dependent manner. So if you can use an extremely small amount of nicotine, then it's not as concerning it along around, but it's not as concerning it along around, but it's a vasoconstructor. And one of the main concerns with it would be cardiovascular disease or even microvascular ischemic disease, that can lead to neurodegenerative disease.

So like a type of dementia that can be partly due to nicotine. If you use nicotine for a very long period of time, especially at a higher dose, it's a dose-dependent effect on your hormone profile. Is that also true for a nicorette and other nicotine gums? At high doses, if you can use an extremely low dose of a nicotine gum, then theoretically that would be maintainable. It's not going to overload the nicotinic receptor. You have acetylcholine and the colonergic system as one of your main nervous systems, of course,

and you have muscarinic receptors and nicotine receptors. There's just better ways to optimize your nicotinic receptor activity. For example, acetylcholine precursors like alpha GPC, phosphatidyl serine, phosphatidylcholine, weak acetylcholine esterase inhibitors, especially natural ones, potentially have a part as well. And then other alkaloids. So nicotine is an alkaloid from the tobacco plant. There is other plants like cytosine and that genus of plants and that alkaloid is also a nicotine receptor acne. Is it true that cycling for too long, literally bicycling sitting on a bike seat too long

can damage the prostate? Yes, it can be very concerning, especially if you're seated while cycling, especially if you're putting a lot of pressure on the perineum. Your core is kind of like a box where your diaphragm sort of makes the top and your abs and serratus make the front and the sides. Your back muscles make the back and then your pelvic floor makes the bottom of the box, which is arguably the most important part of your core. And that pressure can weaken and even lead to incontinence and impotence.

So we were talking earlier today in the gym about how heavy leg work hack squats, dead lifts, those kinds of things. A lot of guys are doing to increase their testosterone. Done correctly can actually augment and build up the strength of the pelvic floor. Done incorrectly can actually weaken the pelvic floor and lead to all sorts of issues, including sexual effects, negative sexual effects.

So how does one go about learning, whether or not their movements are being done properly to support pelvic floor or to destruct pelvic floor? The pelvic floor is a constellation of muscles just like any other kind of like system in the body. You know, form is important if you're doing the Valsalva maneuver, which again is that kind of like bearing down or deep breath where you feel all of your abs are tight. You can also notice that your pelvic floor is tight as well. If you have a history of an inguinal hernia,

which is a whole kind of like connecting the abdominal cavity down through the pelvic floor, or even the scrotum in some cases, then that can be a sign that there is weakness in that area, and you might have to concentrate on it most, or even have a physiotherapist or a physical therapist specifically target the pelvic floor. Many exercises in which you valve salva or use your glutes or legs. You can learn to squeeze them and have that

mind muscle connection in order to help build up the pelvic floor. And there's other things. Many people are familiar with kegels. That is just one of the many different exercises that can help your pelvic floor. My understanding is that while strengthening the pelvic floor is good, excessive contraction of the pelvic floor can actually limit blood flow to the pelvic area, the penis, and so forth. So, this is again, it's a double-edged sword, right? I mean, you don't want guys out there to just start doing endless number of kegels every day, because they're actually going to constrict blood flow to that area, right? And in fact, the erection response is parasympathetic.

It's a relaxed, induced response, right? So for the reason I chuckle is that, because we're talking about things, we don't have visuals or charts, and certainly it's hard to know whether or not a given exercise like Kegels are going to be good or not good. If it's excessive, how many sets and wraps does it take before it goes from good to bad? Is there a kind of general rule of thumb for people to think about this? I mean, clearly blood flow to that area is key for sexual performance and yet when one trains the legs or even walks, you're getting blood flow.

So my understanding is this, that a combination of weight training to stimulate the positive hormonal and muscular and connective tissue growth is key, provides not overtraining. But so is casual exercise, like walking and stretching and the sorts of things that will then return blood flow to that area. Is that an overly basic way to think about it?

Or will that suffice? I think that's a good way to think about it. I think the main point with key goals is there just one of many different things. So if you're having some pelvic floor pathology certainly or even just concerned about your pelvic floor, don't just take the advice, do key goals and you'll be okay. That is not near enough.

It's just one of the many aspects. Okay, so going back to the rapid Q&A, and then we'll come back to this issue of blood flow because there's some interesting science and protocols there. Question I have is alcohol, does it increase a romatase, the enzyme that converts testosterone into estrogen or not,

and is there a dose dependence there? It significantly does. There is a dose dependence. In general, I would not recommend more than three to four standard drinks. One huge glass of wine is probably five standard drinks. But I would say every two weeks. That's consistent with what I discovered researching alcohol and episode we did on alcohol, that no alcohol is definitely better for all aspects of health than any alcohol.

Anyone that says that well, red wine contains these various things. Well, they doesn't contain enough of those positive things to have a positive effect, but that if people do opt to drink alcohol, that two drinks per week and meaning 20 grams of alcohol, so that's probably two 12 ounce beers or two, you know, four ounce glasses of wine is going to be the upper limit beyond which you're going to start seeing all sorts of negative effects. The other thing to keep in mind with alcohol is as a lot of calories, seven kilocalories program, almost as much as fat, which is nine. And then it's also very GABA-ergic, so it can activate inhibitory neurotransmission.

And that can also affect how many, how much LH and FSH is released, so that can also decrease testosterone, almost kind of similar to how opiates can decrease testosterone. I feel very lucky that I don't enjoy alcohol, never really did. You can take it or leave it. Certainly don't like sedatives, like valium or anything like that, which as you just mentioned, can suppress testosterone. You said the word fat, so I'm going to pick up on that and say, in order to optimize hormone production, is it important to have some saturated fat in

one's diet? And what happens on very low fat diets to testosterone estrogen and other steroid hormones? Fat's interesting because there's so many different beneficial fats, omega-3s. Almost every American gets plenty of omega-6s in any developed country, really. When it comes to saturated fat, there is more of a correlation with hormone optimization. If you're eating things with saturated fat, you tend to have those are things with more fat soluble vitamins and things that are very nutrient dense otherwise. But it is not vital. In general, you want to eliminate any trans fat, unless it's trans

fat from the ruminants. There's always an exception to everything, right? So there is healthy trans omega-3 fats, which are formed in the stomach of like grass-fed and finished ruminants. But ingesting mostly olive oils, maybe nut butters in limited amounts, because they're very calorie dense. But unless people are trying to increase their calories, in which case they're a great source of calories, small amounts of butter, ghee, probably okay, but not excessive amounts of something. Yes.

Fat is perfectly fine. Cholesterol has an interest, as a cholesterol and in general, phospholipids make the bilayer that's around the cell. But cholesterol is also a hormone in and of itself because it binds to the estrogen-related receptor alpha. So I consider that like in the estrogen receptor category and they can help with metabolism

but also potentially have concerns for cancer and tumor risk. I want to go back to the prostate and talk to you about something that's kind of a newer emerging trend. I know that you've talked to a little bit about this in a previous podcast that a number of men, I should say, a number of physicians are prescribing low dose to dallophil, also known as sealis, to their male patients. So in dosage ranges of like 2.5 milligrams to 5 milligrams per day, but not for erectile

dysfunction, but rather for improving prostate health. And presumably they get sort of a boost in terms of blood flow to the genitalia as well. But again, not specifically a deal with erectile dysfunction, but to deal with prostate health and blood flow to the prostate. Is that something that you sometimes often prescribe to your patients and of what age? Tidalofil is a very underrated medication. The age would kind of depend on the indication. So Tidalofil is also a blood pressure medication.

It can very slightly decrease blood pressure, especially at higher doses. At higher doses, it's a high dose would be 20 milligrams, not 2.5 milligrams. But consistently, it can somewhat affect with the cones in the eye that have to do with red and green sight, although if you remove it, that effect is reversed. So basically, if you don't need really, really good red green discrimination, you can take higher doses. But in general, I recommend no higher than 10 milligrams a day, usually just two or five milligrams.

One other benefit or other use of tidalafil is that it increases the density of the androgen receptor, similarly to elkarnitine. So, that's an interesting benefit. Another benefit is that if you give it to people with nochuria, which is urinating at night, in general, it will cut the episodes in half. So, it could go from two to one, which can make a big difference for your sleep, which will secondarily make a big difference for your growth hormone and testosterone optimization. Interesting. So, you said 2.5 to 5 milligrams per day is typical for these prostate enhancing effects.

Yes. And you mentioned the potential side effects on adjusting visual perception as a vision and scientist that rings in my mind. But in terms of red-green color discrimination, I'm guessing unless you're going to be a subject in one of the experiments in my lab or you want to be a fighter pilot pilot chances are you can probably get away with a little less red-green color discrimination Correct. It's not considered clinically significant unless Someone is a commercial pilot. Great. So if someone's getting there like pilot exam That's one of the things we look for. Okay, so commercial pilots aside

You might want to ask your doctor about low-d dose to Dallafil for sake of enhancing prostate health. Certainly monitoring PSA, prostate specific antigen is important. I can give an anecdote there. When I tried Cermorland, one of the surprising side effects that was not welcome was a dramatic spike in my prostate specific antigen. No one could explain to me why that would happen. But when I stop taking sormorl and it went back to normal. So it's one reason I avoid sormorl and at least frequent use of sormorl and PSA should be kept below levels of somewhere between one

and four is considered healthy. Is that right? It depends on the age. If there's a 20 year old, likely between zero and one, if there's a 40 year old, likely between one and three, and then if there's an 80 year old, it would not be abnormal to have a PSA of five and have that be well within the reference range. Another thing we should mention about PSAs, if you do take a five alpha reductase inhibitor, like finasteride or due testaride,

often these will cut your PSA in half. So if you, for example, if you have a PSA of six, and you start an astride or do test ride, and then you'll recheck it in six months, and it's 6.5, that is a huge concern because that's actually doubled. Glad you brought this up because I almost overlooked the fact that I get a lot of questions about drugs to offset hair loss. Most of those drugs are going to operate through the DHT system, the dihydrogen testosterone system, for the reasons we talked about before, DHT receptors being on the scalp

and causing beard growth on the face. Is it the case that a number of people taking things like propitia and other things to block the DHT or disrupt the DHT pathway are going to experience diminished, sex drive diminished, you know, kind of motivation and a general vigor. And if so, are there alternatives like topical DHT antagonists that they might use if they want to keep their hair, but not have those negative effects?

The way that I think about hair loss is you have your fertilizers, also under the growth agonist, and then you have your anti-indrigence. Whether they're systemic or topical, there is both. But that's the general layman's way to think about hair loss. If you're only putting fertilizer in your hair, but you have angiogenic alopecia or male pattern baldness, then those hairs will still miniaturize, and eventually you'll still have loss. Such a great word, miniature rise. Yeah. It's enough to send anybody off to find a therapeutic, right?

And by the way, it's difficult to tell if miniaturization's happening unless you have a magnifying glass. You can, you know, for a second there I didn't know whether or not you were making a joke. You're talking about miniaturization of the hair follicle. Correct. So why can reverse that miniaturization? That's just a fun word to say.

I'm gonna just keep saying it. Each individual has, again, we mentioned the androgen receptor, males only have one androgen receptor genus on their X chromosome. So depending on how sensitive that androgen receptor is and depending on the density of the receptors in the hair follicle, you can have a arbitrary threshold and you don't know what this threshold is until you start to have miniaturization and loss of hair.

But over the threshold, the follicle will die and eventually the stem cell will leave. But under the threshold, you're okay. Every androgen binds to the same androgen receptor. So there is nothing special about DHT. DHT is just a stronger Androgen. So the higher your SHBG, things that increase SHBG are beneficial for hair loss prevention because you have less and binding of that receptor.

So if you think about hair loss specifically Androgenic or male pattern baldness in the terms of that androgen receptor and everything in general binding to it, not just DHT, but also testosterone. It's helpful. It's just that DHT is a huge battering ram, whereas the other androgens are just light presses on the door. Got it. So are some of the topical DHT receptor antagonists going to be a better choice for people that want to maintain or their hair or grow more hair if they want to avoid side effects. Likely so, some individuals benefit from systemic, a systemic decrease in DHT for a couple reasons. One could be prostate and then one could actually be hypertrophy of the myocardium. So DHT also disproportionately thickens the ventricle.

So for someone on TRT, that might be a benefit that is prone to thickening the ventricle at baseline. However, many people that have just a bit of predisposition, they can use things that are topical anti-androgens. Keto-con is all of them. Caffeine is actually another one. We're drinking caffeine. Topical anti-androgens Keto-con is always one of them caffeine is actually another one. We're drinking caffeine topical caffeine Oh, I was gonna say my hair tends to grow pretty fast So maybe that but I drink a lot of caffeine so topical caffeine really rubbing coffee on their head

Yes, we're taking caffeine tablets and how does it wait? You have to explain how this works How do people get caffeine into the hair follicle? How do people get caffeine into the hair follicle? Um, topically, the caffeine enters the scalp and crowds out, like, somewhat crowds out the enders. And it is a weak effect. It's likely just strong enough to be clinically significant. Usually caffeine is put into formulations with other things like keto-conousol that are also weak anti-androgens.

Of notes, spironylactone can be prescribed topically, but it is absorbed systemically because these size of the molecule. So unless your doctor specifically prescribes that for you, especially as a male, do not use topical spironylactone, topical finasteride is also a smaller molecule. So it is also systemically absorbed,

but it is not extremely well systemically absorbed. If you take topical finasteride, and usually your systemic DHT will decrease by about 30%. Topical Dutastride is likely a tiny bit systemically absorbed, but it's unique, because it's half life is much faster at a lower dose. So topical Dutastride will not affect your systemic DHT at all, and I've seen this anecdotally on many people on top of cold due test ride therapy. We're going to have to get you back on here doing episode all about DHT and hair loss and hair growth. You know, again, not a topic that I focus on a lot for myself, but that I get a lot of questions

about for men and women. One thing that we could mention, I got a ton of questions about turmeric and curcumin oids after the last episode. Oh yeah, but I had reported my own anecdotal experience that taking turmeric really crushed my DHT levels and I did not feel good. I mean, crushed all sorts of positive feelings of vitality. The moment I stopped taking turmeric felt great again. Many people report this and the interesting thing about turmeric is most of its beneficial action,

not all of it. Some people benefit from systemic turmeric and some people that can tolerate it. Well, it's actually great for the prostate, but most of the action it does not need to be bioavailable. It acts on the gut microbiome. So you can take turmeric, and if it is not absorbed, some turmerics is put in special formulations like my cellar or liposomal, or complex, but a lot of it is put with black pepper fruit extract, which is also known as biopurine, which is actually also a five-alpha reductase inhibitor, and it affects liver cytokroms. And so many supplement companies put this black pepper fruit extract, bio-pearing, and almost everything.

So some people are on a really high doses, and that could also be making most of the effect of people who do not tolerate turmeric well. Yeah, I avoid turmeric like the plague based on that one previous experience, because it was clearly turmeric that caused the negative effect coming off it, everything reversed rapidly. And by appearing the black pepper extract, I also avoid that like the plague based on everything you just sent.

I want my five alpha reductase, I want my DHT to be optimized, simply because my understanding is DHT is the more powerful ender gender-jana, it's the one that, yes, it causes a little bit of hair loss, and I've got a few patches here and there, but I'm willing to live with that based on all the other wonderful things that DHT optimization does. I'll quickly mention a few other things.

One, Saul Palmetto is also a five-offer duct-saces inhibitor, but only a couple of the isoenzymes. There's three main isoenzymes, and a lot of the problem is that you're inhibiting a couple of the isoenzymes, but not the other one. Phenasteride inhibits one and two. Dutastride actually inhibits all three. And phenasteride inhibits the isoenzyme that is in genital skin, but not in the skin throughout the rest of your body.

So a lot of the side effects of phenasturide, which is loss of sensation and loss of erectile function, have to do with the disc concordance between the sensitivity of the genital skin and the skin. Again, another reason to not disrupt five alpha reductase. And we'll definitely get you back on here to talk about, I think we should just do a whole episode about DHT because so often when people are thinking about optimizing hormones, especially males, males trying to optimize their hormones, they're thinking testosterone testosterone. Maybe nowadays they think a little bit more about free

testosterone and maybe they think about estrogen is also being important not to crush estrogen, but DHT is, you know, at least to my mind, the linchpin of so many of the things that subjectively people are really focused on libido, motivation, drive, etc. I have one final question. It's just a brief one, but many of us have heard that the BPAs that are present in plastic bottles and even in certain aluminum cans and thallates, a difficult word to pronounce, but a fun one nonetheless. Thalates and work by Dr. Shana Swann has shown that thalate exposure to the fetus,

to pregnant mothers and defeatuses, very likely is negatively impacting sperm counts, testosterone levels, and even changing genitalia size for the worse. In males nowadays, I saw a beautiful lecture that Dr. Shannis wanted on this when I was in Copenhagen, and it's very clear that it's negatively impacting the male fetus. She was also in Joe Rogan's podcast.

I hope to get her on this podcast. However, what she couldn't answer for me was whether or not Thalates and BPAs and these things present in plastics and some people who claim in tap water are bad for males after they're born and after puberty. What are your thoughts on, or I should just ask you, do you drink water out of plastic bottles?

Do you avoid drinking out of cans that are not specifically non-BPA containing cans and do you actively avoid thalates? My understanding is that thalates are most enriched in pesticides, and that's why you're seeing dramatic drops in sperm and testosterone levels mainly in rural areas where they're dust cropping. So I do avoid drinking out of cans that are plastics that may have BPA or bisphenol A in them. Bisphenol A is known to bind to what I would consider the fifth estrogen receptor, estrogen-related receptor gamma. I would consider it a Xenoestrogen. So phytoestrogens are estrogens from plants, and in general they're not concerning or clinically significant. Xenoestrogens are just other estrogens. So I do avoid BPA, and I also test my water.

I use a water testing service and I test it both after it's through my water filter and the tap water that my two boys drink almost every day. And it was very interesting. I only found one microplastic just a bit over the reference range. So it wasn't a terrible tap score, but even in developed countries,

these are widely variable. As far as put that late, again, very difficult and interesting for two pronounce, but I remember learning about these because there was, I believe, a lawsuit that had to do with mac and cheese. And this is probably five years ago, and I was coming up with my list of each provider that does obstetrics has a list what to avoid for the pregnant lady. You know, sketchy deli meats or high mercury fish like swordfish and salmon,

and I actually added processed mac and cheese to that list. Interesting. Well, thank you for that. I'm going to extract your statement that you avoid drinking antiplastic bottles. When possible, I'm guessing you're not neurotically attached to that. If you're dying of thirst,

you might crack a plastic bottle of water to survive. But it's in Kyle, Dr. Gillette. Thank you so much. You gave us an enormous wealth of knowledge, everything from behaviors to psychology, to supplementation, to prescription drugs, we will make sure to point out where people can get a hold of you on Instagram

and on Twitter and on other websites in our show note captions. But really just on behalf of the audience and just for myself, thank you so much. You have an immense amount of knowledge and you're exquisitely good at sharing it with people in an actionable way. So thank you. My pleasure. Thank you for joining me today for my discussion with Dr. Kyle Gillette all about male hormone optimization.

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