The Nick Bare Podcast - 013: Dr. Kyle Gillett - The 6 Pillars for Optimal Health, Hormones, and Vitality

Episode Date: May 22, 2023

Today on the show, we have Dr. Kyle Gillett, a renowned advocate for holistic individualized care. With his vast expertise spanning preventive medicine, aesthetics, sports medicine, hormone optimization, infertility, precision medicine, and genomics, Dr. Gillett passionately believes in a comprehensive approach to achieving optimal health. In this conversation, we delve deep into the core principles of his practice, centered around the concept of the 6 pillars of optimal health. Focusing on understanding the intricate balance of hormones, we explore the transformative power of hormone optimization and when it's ideal to begin blood work. Additionally, we tackle the crucial topic of finding the right doctor for hormone replacement therapy, unraveling the importance of shared decision-making and an evidence-based, patient-centered approach. BPN Key Lime Protein: https://bit.ly/bpnkeylime (code NICKBARE10 to save 10%) Follow for more:  IG: https://www.instagram.com/nickbarefitness/ YT: https://www.youtube.com/@nickbarefitness Keep up with Kyle here: IG: https://www.instagram.com/kylegillettmd/  YT: https://youtube.com/@gilletthealth  Clinic: https://gilletthealth.com/ Topics: (00:00) Intro (1:38) Kyle’s background (5:17) Comprehensive blood panels (10:17) Beneficiary of critical thinkers (11:47) Increase of interest vs. issues (14:31) Six pillars of optimal health (22:00) Diet and exercise fix most health conditions (26:24) Optimal diet for everyone (27:30) Hormone optimization through diet (30:08) Individualized diet approach (31:26) Precision medicine (33:46) Gut health complexities (38:55) Increasing gut motility (42:40) Effective probiotics (48:03) Diversified diet (49:41) Exercise protocols (51:23) Impact of endurance training on hormones (1:00:25) Sleep cycles and circadian rhythm (1:03:13) Best time for sunlight (1:04:27) Red light therapy (1:05:13) Optimizing sleep and sunlight (1:09:05) Tips for sleep in a caloric deficit (1:11:58) Stress management (1:16:39) Spiritual health (1:21:43) Male vs. female hormone optimization (1:25:03) Issues of contraceptive methods (1:31:51) Issues of tele-doc for HRT (1:35:19) Optimal male hormone health (1:38:14) Determining the ability to build muscle (1:44:13) Factors to consider before taking synthetic hormones (1:48:17) Accessibility and use of TRT (1:51:56) Why do most individuals utilize HRT (1:55:10) Finding the right doctor (1:57:14) The right age to start blood work (2:00:27) Age of declining testosterone

What age do hormones start declining? 25 or 30. And from there, it's just downhill. Statistically, yes. You use it or you lose it. If you use it and you have good diet and good exercise, you can maintain a lot of your strength and body composition into older age. So you have an 80 or 90-year-old male.

What's the highest testosterone you ever seen in so on like that old? Nine hundredths. Wow. Was he just thriving? Indogynously produced, of course. He didn't have metabolic syndrome. He didn't have sleep apnea. He was very active.

He exercised a lot. He dieted a lot. He slept well. So he had a lot of the pillars of health checked off. I'd love to talk about the six pillars of health. So the first two are diet and exercise, and those are pretty self-explanatory, sleep, sunlight, stress, and spiritual health. And then Rich Roll convinced me I should add a social health as my final seventh pillar

of health. I think the last two to three years have been a good example of why social health is particularly important. Before we dive into today's episode, I want to thank you for tuning in and supporting the podcast. Now, we just launched and released a new flavor of way protein. And this is my signature flavor. Quite possibly the best flavor of weight protein we've ever created.

And it is key lime pie. If you like key lime pie, you're going to absolutely love this flavor. Even if you don't love key lime pie, you're probably still going to love this flavor. It's a limited launch. So once we're sold out, we are sold out forever. You can go to the link in our description and use code Nick Bear 10 to save 10% off your order. So go try our key lime pie away protein and let us know what you think. Today on the podcast we have Dr. Kyle Gillette, owner of Gillette Health,

whose practice includes preventative medicine, aesthetics, sports medicine, hormone optimization, obesity, infertility, integrative medicine, and precision medicine including genomics. Welcome to the show. Thank you for having me. How you been? I've been well. It's good to be back in Texas. I have been looking forward to this conversation for quite some time.

I'm super interested in optimization, human optimization. I think it's taken too far, and I think I've taken it too far at times. But specifically, kind of as we've talked about back and forth before we started recording, hormone optimization. I've experienced crashes to my hormones over the last couple years that I contribute or attribute to training, stress, lack of sleep, being an entrepreneur, building a business. But I'd love today to dive into your six pillars of health and hormone optimization. Certainly. I suppose you have a fairly unique viewpoint or empathy towards three main groups of individuals who tend to struggle with hormone optimization, bodybuilders, natural bodybuilders,

well, all bodybuilders, actually, and entrepreneurs, and also endurance athletes. So you have experienced all three, and I would assume that there is a lot that we can go over. I know I've seen your recent labs, but looking forward to the discussion. Absolutely. Well, I'd love before we kind of dive into this episode, if you could kind of give some background on your medical experience, kind of how you fell into this lane of study and where your passion really exists in medicine and specifically preventative medicine. Certainly. So I've known that I wanted to be a medical doctor since I was 12 years old. My father is a family physician. He's practiced for more than 30 years at a faith-based practice.

He delivers babies. He sees the newborns in clinic. He sees geriatric population. So think of doctors like us as kind of the last of the Mohicans, full spectrum doctors. So I knew I wanted to be a family doctor. And as I went through my medical education, I tailored my education to be able to take care of people holistically, body, mind, and soul in many different ways. And one thing I noticed is everybody told me don't do family medicine. That's where people that don't have, you know, like that's where you go if you have bad scores or whatnot. There's a huge stigma against doing family medicine, even though it's the most complicated field because you have the widest breadth of knowledge that you need to be well versed in. And then I want it to be good at things that are

common. So obesity and metabolic syndrome. I got board certified in obesity medicine as well. And hormone dysfunction. Hormones are the signaling. molecules that, you know, that's literally what they are. They signal from one organ system to another organ system. Those are endocrine hormones. There's also hormones called autocrine and paracrine that signal between closed systems. But there's also a stigma against checking hormones. Just try going to a doctor and saying, I just want my testosterone and estrogen and IGF1 checked. And you're unlikely to get it checked. So I became as good in those things as possible. If you go to a doctor's office and you ask for a comprehensive blood panel, is it going to have hormones on there?

A comprehensive blood panel at a doctor's office is probably a CMP, so that's your electrolytes, your liver, your kidney markers, a lipid panel with an LDL, no APOB, certainly no LP little A. A doctor probably doesn't even know what that is. Probably an A1C, if you're lucky. CBC would be included in most. fasting insulin would probably not be included and I would consider that a bare bones blood panel so it's very unlikely that hormones would be included even if you're menopausal or having hypogonal symptoms is there a reason they wouldn't be included considering that a lot of these biomarkers

give us a lot of information into what is going right and what's going wrong yeah there's a lot of reasons for that but at the end of the day it's cookie cutter medicine um providers healthcare providers have a very small amount of time to spend with a patient, often just 10 minutes. And ordering more labs requires more interpretation. And if you're just getting your baseline blood work, then they would

want a second visit to assess something else. So let's say you're going in for your annual visit. They have 10 minutes. They say, we'll come back. Then we'll talk about your low libido and mood symptoms and like what stressors you have and then discuss doing the labs. Then you come back for another visit, every visit they can bill what's called a 99213 or 99214, and that's how they get paid. They don't get paid for answering messages. So they're disincentivized to answer messages when you type in and you ask a nurse something. They're working for free. And that's one of the problems with our health care system is the health care provider is disincentivized from answering messages and talking to the patient unless they come in in person and get a visit. And then the

patient is disincentivized from coming in in person because they probably haven't met their out-of-pocket max yet and they're going to be hit with the copay. You know, I was kind of explained to you before we started recording, I never really got blood work done until 2021. And the reason I got blood work done then is because I was in an Iron Man prep and I was feeling extremely fatigued, beat down and tired. So I'm thinking something's got to be wrong. So I got my blood work done. And so I think my testosterone at the time, my total was like 309. which I thought was like extremely low. Now considering during this bodybuilding prep,

but my numbers came in at 109. I'm like, oh, 309. It's like, I'll take that anytime, any day. But after I started doing some research on, you know, hormones and my hormones and how to optimize, I told my dad who turned 60 this year, I was like, hey, dad, you should go get your blood work done. Just see where you're at.

Just get some, like, baseline data to see what your biomarkers are sitting at. So he went to his primary care physician back home in Pennsylvania and asked to get his testosterone checked. And his doctor was like, why do you want to get that checked? Absolutely not. We're not doing that. So I thought that was very interesting that there was so much pushback

because he wanted to see where his baseline data was sitting just for peace of mind. And I thought that was so wrong and out of the norm. Yeah, there's a buzzword called patient-centered medicine, and we should be, as health care providers, we should engage in what's called active listening, which is listening for what the patient's goal is. And this is what we're trained to do in medical school and residency, but the system is not designed to allow us to do that. So you have this false dichotomy of conventional medicine, where you basically are just an algorithm robot, and you have to go down the checkmark because mostly based on what insurance covers, that's what patients are willing to do. I've ordered, when I, back when I didn't have my own clinic, when I worked for a more traditional system, I've ordered a basic hormone panel, estrogen, testosterone, Dht, and insurance decided not to cover it. So they, just for those few basic labs, they charge the patient $700 or $800. Wow. The average markup from a wholesale lab

cost to what the, to what you will be billed for if insurance doesn't cover it is a thousand percent. So 10 times as much. That panel wholesale would likely cost for just those few hormones, $70, which is a little bit expensive, but some hormones like Dht, and if you get the right assay for esterdial, they can be more expensive. Then when that happens, of course, I try to do my best, so I file an appeal, or I file a prior authorization, and then after an appeal, you do a peer-to-peer, so you talk to one of the usually pharmacists or non-practicing medical doctors that hasn't practiced in decades. And there are, of course, exceptions.

And then you try to convince them to cover that test for the patient, and it's very time-consuming. Did you take this approach to medicine from something you learned from your dad, mentors, or is this something that you found on your own that you identified as,

like, this is going to be something I'm going to really focus on to help people feel better? A combination of both. Part of it is intrinsic. I've always been kind of like a creative critical thinker. I was homeschooled. My brothers were as well.

My older brother's a dentist. He's one year older and we've gone through most of life together. So I was fortunate enough to, I think the saying is like stand on the backs of giants or something like that, is that good people that are also critical thinkers will pull you along in life. And I have certainly been the beneficiary of that. And I continue to be the beneficiary. and what I call an interdisciplinary team or an academic center without the red tape.

So there's a huge amount of benefit. Anybody who's been to medical school or residency knows that if they have a question and they have a whole host of attendings and dietitians and other various health care providers and experts that they can ask. Whereas outside of that system, often it's a solo practitioner.

Or they just have, they contract with doctors that don't even talk to each other, So there's no collaborative effort. So a lot of my, the way that I practiced and how I got here was determined by that. I do want to talk about the six pillars of health that you focus on being diet, exercise, sleep, stress, sunlight, spirit. But before we do, I'm curious on your opinion, you know, I've seen over the last couple years, there's been a huge increased awareness for hormone health, mental health, gut health,

kind of like we were talking about previously. Is this new awareness because there is more talk around these topics? Or are we experiencing lifestyle and environmental factors that are causing these issues to be worse to larger populations? I think most of the cause of increased interest is, media interest, podcasts like this. However, that being said, they are getting slightly more common. So there's a program called Healthy People 2030, and every 10 years, I believe it's a collaborative effort, CDC and a couple other organizations. But every 10 years, they reassess general health

parameters. For example, what percentage of Americans have pre-diabetes and what our goal should be? And depending on the trend, their goal might be, you know, essentially no change because they know that diseases like metabolic syndrome are becoming more and more common. So it's a little bit of both. I think there's also a shift in the culture of what is okay to look at. For example, in the past maybe 10 or 20 years ago, it became okay to say, you know, I am struggling with mental health. you talk about depression, you talk about anxiety, that's okay to talk about now. Whereas now there's a similar phenomenon happening with hormone health and also, I would say, sexual health.

Do you think it's because of, you know, you hear people talk about all the time, it's because the plastics in our food and in our environment, it's because of herbicides and pesticides, it's because of the heavy metals. Are these the issues that we're experiencing? In your opinion, what are the environmental factors that are. causing the biggest shift in hormone fluctuations. All those things are contributing, but they're not the knockout blow. So you think about bisphenol A, you think about phthalates, and those are xenoestrogens or

xenohormones. And you think about like what the strongest cause is, it's not that. It's metabolic syndrome and sleep disorders, like sleep apnea, pre-demeanor. pre-diabetes and insulin resistance. So those are the largest contributors, but all these other things are also contributing. I'd love to talk about the six pillars of health. And kind of, before we dive into each one of those pillars,

how did you get to the point of establishing six pillars of health and where were you at in your career, your medical professional career before establishing those? And then why introducing those to your practice? Yeah. So the first two are diet and exercise, and those are pretty self-explanatory. But I do like to say the optimal diet and exercise regimen is one that the individual will adhere to. So it's not a cookie cutter program that everybody does the exact same thing. And I got involved in diet and exercise even before med school. There's actually a huge emphasis for what's called lifestyle medicine. There's lifestyle medicine certifications. And there's a group called food is medicine. And there's another group called exercise. is medicine. And I was involved in both through medical school and they were extremely popular groups. So I know that at least in the Midwest, there is a huge number of medical doctors that truly believe exercise is medicine and food is medicine. And they want to be able to prescribe

those things. And they have prescription pads where they can, but sometimes time is a rate limited factor. And also a lot of patients don't want to hear that from their health care provider. they don't think that they're interested, but I know that there's a lot of my other colleagues that are. Past that, I developed the pillars of health because a lot of times you'd write behavioral interventions that are not diet or exercise related,

and then I used alliteration, so they all had an S. So those are sleep, which is arguably the third most important one. Sunlight, that just incorporates being outdoors. It's not natural for humans to be indoors in climate-controlled environments all the time, that also is heat exposure, cold exposure, etc.

Sunlight is the next one, and that's not necessarily like going out and getting a tan, although there is some truth to feel good, look good. That also includes circadian rhythms. And then past that is stress and spiritual health. So just like anything else, you want to feel good if you're lifting a weight in the gym. You want that effort to feel good with stress.

Stress is the normal part of life, but you don't want it to be so much that you can't handle it. But you should teach yourself to be able to handle higher levels of stress, just like you progressively overload, lifting a weight in the gym. And then after that is spiritual health. That was initially my last one. That's Maslow's hierarchy of needs. Once you address your physical needs,

that self-actualization at the top of the pyramid is particularly important. And then Rich Roll convinced me I should add a social health as my final seventh pillar of health. I think the last two to three years have been a good example of why social health is particularly important. I agree with that. My wife and I were talking as we were walking our daughter last night in preparation for this podcast about that social part of your life and how much of a health requirement it is. We found parts of our life where we're so focused on work and our family and caring for. for our daughter, and the first thing we typically eliminate is our social lifestyle.

And we immediately feel that. You know, we stop going out to dinner with friends or meeting with groups of people or, you know, we just kind of stay in our bubble to get things done that we have to get done. But like there's an immediate, you know, effect to neglecting social health and in your lifestyle. Yeah, it's interesting. Now that I have two young kids, whenever you go do something social, there's that fixed cost that you have to incur. And it can certainly bring upon ourselves a lot of stress. And, you know, you're trying to figure out where do you drop them off or are you going to get them ready? Are

they going to get sick at the last minute? Then you have to cancel on everybody. But then when you actually do get to the social interaction point, it feels extremely good and you were extremely happy that it happened. Yeah, like me and my wife went on our first vacation with our daughter a few weeks ago. Went to Florida. And getting to Florida for a vacation with a nine month or the time, with all the things that she needed, I told my wife by the time we got to Florida, I was like, that felt like a marathon. Yeah. You know, the day started at 7 a,m. Didn't end until like 10,000. 30 p.m. And that day was tough and rough. But the remainder of that vacation, hanging out with people and friends and going to the beach and going to dinners, all worth it. Absolutely blast.

But there's this big effort you have to put in that front end and the back end. You know it's coming, but it is worth it for the social experience you get out of it. I have a lot of empathy for that. The other thing that sometimes it'll come to mind is your young kids are also experiencing that with you. So how you adapt and respond to the stress of getting ready for that or how you adapt and respond to travel, they will pick up those things as they age as well. Yeah, I think we learn a lot of this from our parents too because I remember, you know, traveling with my family growing up.

my dad is a stressful traveler. So we get to the airport. He'd always have us there like three hours before the flight was taken off. He was always rushing to the gate. My mom was always chill, hanging out back. And I find myself stressing now that I'm traveling with my family

at the airport. And I'm very conscious of this because I know my daughter as she grows up, she's going to see this and watch this. But I don't want to be known, you know, within my family as the stressful dad. the stressful traveler

or the stressful worker I want my family my kids to view me it's like oh dad he's he's chill he's relaxed like you know

I tell this story a lot but when I first joined the military um this is a side note but it has context in what we're talking about when I first joined the military

I was asking this this captain from the 75th Ranger regiment you know I'm about to get my first platoon, I'm about to be a leader in the military. What's one piece of advice you can give me? And he pointed across the room to this other 75th Ranger officer. He said, you see that guy over there? When shit hits the fan, when things go absolutely nuts, that guy is as cool as the other side of the pillow.

You'll never know he's stressed or that there's chaos striking. He is just calm and chill. I was like, man, I want to be that guy. Like when shit hits the fan, I want to be as cool as the other side of the Now that I'm a dad, especially leading a family, that's how I want to be perceived by the people in my life. Certainly so. It's like you're endogenously producing Xanax in your veins. Your gabberchic system is just hypersensitive and you're able to consciously control the fight or flight aspect of your nervous system, even when most people couldn't. And I think a lot of that is learned, and that's part of the reason why stress is a pillar of health. Yeah, adaptation of. Yeah.

So diving into the six pillars of health, you know, the first two being diet and exercise. My question is, do you think that most or all health concerns and issues can be addressed and solved or cured with diet and exercise? It's hard to think of a condition. I'm sure you can think of examples, but almost all health. health conditions are solved with diet and exercise. That being said, the way that, so there's obviously a balance of the situation. I'm not anti-medication. I'm certainly not anti-supplement. And at the end of the day, medications and supplements are very similar.

They both have pharmacodynamic effects, drugs effect on the body, and pharmacokokinetic effects, how the body metabolizes and uses it. But the approach to every condition should be what lifestyle recommendations, including diet and exercise can be done to improve this condition. An analogy I sometimes make is if you're walking in the forest and you happen upon some quicksand. That's your pathology. So you should teach yourself how to climb and or swim how to get out of the quicksand. You need to move to do that, but don't be afraid of using a tool to do so, hopefully a temporary tool, like a shovel. And that tool is the medication or the supplement. So it's something to help the lifestyle intervention work better.

There's something not to rely on forever and become a crutch, but use temporarily and then use food, diet, nutrition, exercise to be that forever solve. Correct. And in some cases, tools are particularly powerful. So it's not just shovels. They may have a backhoe or a crane, and the crane might pull you out of the quicksand. and then put you back down. But if you don't learn the lifestyle intervention, GLP-1s, like Simaglutide would be an example of a crane. But if you don't learn the lifestyle interventions

to walk out of the quicksand pit at the same time, then as soon as they set you back down on the quicksand, you're going to sink right back in. At what point do you start introducing some of these tools, this medicine, and you find that patients view this as oh, I don't have to now keep the diet and lifestyle and exercise interventions going because I have this tool and I can rely on that.

Very often. And this is where physician-patient rapport is particularly important. So it's often not as simple as just getting the medication from someone at a med spa or whatever other clinic and then you see them once a year and then you're magically improved. So there's certainly no magic medication or supplement. but that's where shared decision making comes in. That's where you and the patient both understand the limitations and the benefits of the medication or supplement and how it should be used best.

That's where active listening comes in, where I am paying attention enough and I'm actually talking to the patient enough to understand where they're at and what their understanding is. To really focus on diet, do you think there is an optimized diet approach? Because, you know, when I first got in the industry, 2009, you know, I went to school for nutrition, I wanted to school for nutrition thinking that we were going to be learning how to build our bodies and get stronger and get bigger and put on muscle, I was quickly disappointed to realize that nutrition in a university was focused primarily on the dietetics route of cardiovascular disease and diabetes.

So a lot of the nutrition protocols and practices that we were learning about were for intervention between those diseases. So then I kind of took a different path. Do you think there is an optimized diet approach that is cookie cutter that can be applied

to everyone because we're so bombarded with vegans better, plant base is better, carnivoreff better, paleo is better, like all these different things that were being told, a lot of people don't know what are an optimal diet? The optimal diet that's non-cookie cutter is the diet that everybody will adhere to,

which is, of course, different for every individual. But you can loop, you can somewhat lump groups of people in. There's trends that you can see. For example, for the average individual with metabolic syndrome, for example, high fast in insulin, an A1C of 5.6 or above, their body fat percentage is, let's say, over 20%. your average American, really, a diet that is high in foods of low caloric density, but high

nutrient density is the optimal diet. Whereas for an individual, perhaps like yourself or an endurance athlete, someone who is trying to leverage performance outcomes, then one common piece of advice that I give them is don't be scared of carbs, including timing them around your workout. So there's definitely trends that you can see from time to time. Another common trend is if you're not going to supplement with omega-3s, especially if you live near the center of the country, think about quality omega-3 sources in your food. What about diet intervention or different types of foods

to optimize gut health and hormone health? You know, from my understanding, a diet higher in dietary fat, with some cholesterol is great for hormone optimization. But like we're, where is too much and too little? Like, should we focus on fat?

Should we not focus on fat? Should we use blood work and biomarkers to guide our diet in terms of do we need to limit cholesterol? Do we need to limit sodium? Stuff like that. Yeah, so the leaner you are and the more of a caloric deficit you're in,

the more important it is to include higher amounts of fat. that maintains higher levels of total testosterone while you're dieting. That being said, an individualized diet program is always going to be better. And when you're looking at, so if you're worried about cholesterol, what you're probably really worried about is cardiovascular disease or atherosclerotic plaque. That's where plaque builds up in the small arteries around the heart or the brain or even the genitals.

It can build up there too or the legs. And for that, you want to look at APOB. which is even more closely correlated with plaque buildup than LDL or bad cholesterol. So if you look at APOB, the way I think about it is APOB years. Kind of like the concept of pack years for smoking. If people aren't familiar with pack years for smoking, that's basically your number of packs per day times the number of years you smoked. For example, five packs a day for one year would be five pack years.

One pack a day for five years would also be five. pack years. And APOB seems to have that same cumulative effect to where you can let it run extremely high for a many number of years and not have significant plaque buildup. Conversely, you can also have it relatively low for a lot of number of years. And if you live longer, eventually it's likely to affect you. So if you look at the coronaries, which is the arteries around the heart of a 100-year-old, then if it's been high even transiently from time to time, they're likely to have some degree of plaque. Some people say, well, it's not just cholesterol,

it's also inflammation and insulin resistance, and that's certainly true. So the way I think of those two things is inflammation and insulin resistance is like the glue that builds the plaque wall, but the APOB and also LP little A, those are the blocks. So you have to have both glue and blocks present. Do you think diet is so uniquely specific to the individual and here's my example of that,

you'll hear people say that they went on a plant-based diet and inflammation went down. And you'll hear the person right next to them said they went on a carnivore, meat-only diet, and their inflammation went down. So you'll hear this contradicting information on both extremes. What is right?

What is wrong? Is it that unique to the individual? It is that unique. There's even a SNIP, which is a single nucleotide polymorphism, you can test your genetics. And if you have that allele, which is not particularly common, if you consume high amounts of seed oils, your CRP increases by about half a point. For example, from one to one and a half. And ideally CRP is under 0.5 a lot of the time. For people who exercise a lot, then perhaps under 1 is a more reasonable goal.

but even a single gene like that can make a difference. It's also well known that there's a gene. I know it's very prevalent in Iceland to where you can hyper consume carbohydrates and it has little to no effect on developing insulin resistance. So it's very individualized. We talked about kind of comprehensive blood work and getting that done and including hormone blood panels in there as well, bio-markers. from your perspective, what's like the,

if I'm going for the grand slam of, I want to know genomics, I want to know blood panels, like what's the grand slam of getting baseline biomarkers done that gives me everything and anything? The grand slam would be the best way to do it. So there would be two stages.

You get your serum biomarkers done first instead of everything at the same time. I know a lot of clinics and whatnot have cookie cutter. You know, you get your gut microbiome mapped no matter what. You get your salivary hormones, no matter what. You get your genomic snips, which is... Snips aren't the only type of mutation. Snips is basically...

This is a little bit of a rabbit trail, but it's like one letter of one word, of one sentence, of one paragraph, of one chapter, of one book of the encyclopedia Britannica. So one gene might be like one sentence. and the gene can have other mutations besides that one word that's changed. It can have a word deleted. It can have a word repeated. It can also have a shift in the words.

So even if you have or don't have the SNP, it might not be clinically significant. So I find the best way to do precision medicine or, you know, like full Grand Slam diagnostic workup is to start. with serum testing and see where it guides you, and then order the pertinent tests for individuals that need it, and don't order tests that are unlikely to be pertinent. Is that the approach you guys take in your practice? Yes. That being said, and I've gotten this question enough to where I posted lab panels, if people

want to go to our website, they can look at these lab panels, but if people just want the highest yield tests in general, they can get what I'd call a complete panel. So a complete panel has for the average individual the highest yield and also most accurate tests for hormones, inflammatory markers, vitamins, electrolytes, lipids, etc. I do want to talk about gut health a little bit. And before we start recording, we were talking about this a little bit. The gut has always been very interesting to me because of how complex it is and how much we actually don't know. and I could be wrong. I kind of want to take this approach to it first.

Is it that we don't know much about the gut because of how large the gut is and from both ends, we can only access so much. So there's so much of the gut that we actually can't access on a living person, and that is just a mystery to us. Is that part of the reason

it is so complex and confusing? That's certainly part of it. Another reason why it's difficult is there's many things that are outside the gut. So even if you could have like a permanent endoscopy, so you have tubes looking and cameras from both ends or capsulography, if that gets better. But even if you had a real-time picture of what's in the gut, there's a lot of changes outside the gut that are influenced by it. For example, postbiotics, nerves that go back and forth between the gut and the brain,

hormones that are produced in the gut itself, and then also the immune system, their main essentially military bases are in the gut, whether that's pyres patches or, for example, even the appendix or the tonsils are basically military bases for your immune system. So you can't get a good idea of what's happening there. The way I think of the gut in general is it's the training ground for your immune system. So for someone who comes to you and is having gut issues or so they think they're gut issues, what's your approach? What's the first step?

Because I personally, I've done a lot of Googling and self-help and self-diagnosis. And I'm like, okay, well, you know, for example, after my bodybuilding show, I was having a lot of stomach, distress, gut, discomfort, bloated, gassy. so I did some self-research. I was like, I'm going to try this very specific bacteria strain.

As I was telling you, I colonized it, I fermented it, I turned it into 90 billion CFUs and it didn't have the effect that I was hoping and wanting for. So I have found that I've tried to self-diagnose lots of things in my life, but the gut specifically. And I'm always, always missing. So what is step one of figuring out what's going on and how to fix it? With any pathology, a provider, whether it's a MD or an RD, a dietician, or regardless of the provider, even a health coach, generally should start with the history first. So the subjective and then include that with the objective.

So the clue that you were preparing and then finishing a bodybuilding show is a huge clue. and that can tell you a lot about what it's less likely and more likely to be. For example, your stool frequency was probably somewhat slowed at some point during prep. Just because of decreased caloric intake and then presumably you had like very low volume. So you probably didn't consume a whole lot of fiber right before your show because you don't want that to sit in your gut while you're on stage. And then the rebound from that, think of it as like after winter you have a bacterial bloom, an overgrowth, of methane-producing bacteria and hydrogen-producing bacteria. And it's going to be a bit of a wave peak in a trough until hopefully it evens out in the

long run of things. But other clues can tell us, you know, what foods trigger it, what is your diet, getting a diet recall, even if it's just a 24-hour diet recall. Often starting with a care with a dietitian that's accustomed to. to treating similar cases. For example, a sports dietitian. I think it's called CPSDA. That's basically the sports dietitians

that take care of individuals in very similar circumstances. The one that works at our clinic, her name's Diana, and she is excellent. And often, even without doing, you know, a lot of functional medicine clinics, I don't consider myself a functional medicine provider other than that I like to treat the root cause

of each pathology. But it's not necessarily, like, what someone shouldn't do in that situation is just go to the internet and then buy a GI map that can't help for some individuals. But that's just basically testing what dead or excreted bacteria are coming out the other end. It's like testing the exhaust out of your car. It'll tell you some. It's not completely worthless.

But getting that subjective information about what's going in and what circumstances you have is very helpful. Would you argue that most gut issues are an imbalance of bacteria? Not just an imbalance in bacteria. Most gut issues also have to do with motility, either disorganized motility. So the process of peristalysis is where you squeeze the gut. And as you squeeze the gut, you can do it in an organized matter that's going to push things along or disorganized. So things like cholinergic tone can affect this quite a bit. In fact, the diagnosis of IBS, perhaps we can talk about that too, is extremely common.

But it should be what's called a diagnosis of exclusion. That means all other causes should be ruled out. But because it's the gut, it's pretty much impossible to rule out all other causes unless you have a very vigorous workup, including endoscopy. So that being said, a lot of people are still diagnosed with IBS, partly just to cover medications. but organizing that, one very common treatment is bental, which basically just paralyzes the gut because it's an antichic. So the acetylcholine is no longer working. So you don't feel the symptom, but the cause is still there.

And that's one way that it's unrelated to bacteria. The other way that it's not as directly related to bacteria is immunological conditions like crones. So if motility is the issue for a lot of people, how do you increase the motility? And does bacteria, you know, say taking a probiotic, for example, does that help improve motility to empty bowels more efficiently? It can. There's a lot of inputs.

So we mentioned acetylcholine as one. Opioid receptor agonists and antagonist are another one. So people are familiar with emotium or loparamide. That is a mu-opioid receptor antagonist in the gut. So it blocks that receptor. So, or sorry, low paramede is an agonist at that receptor. So it can help condition, like some cases of diarrhea, can be particularly helpful. Gluten and casein also activate that same receptor.

So that's why a lot of people are empirically put on a low dairy, which is low casein and low gluten diet, and that might restore some of the motility of the gut. That's also probably not addressing the root cause. That's just helping the motility. that's why some people take things like senna. Cynicides is an herb that helps with contraction of the gut. And that's also why a lot of people who stop using nicotine, whether it's a vape or a gum or whatnot.

Nicotine is, there's a receptor called the nicotinic receptor. Acetylcholine also binds that. It also helps with motility of the gut. And then we could also mention things like caffeine and adenosine. that's why one of the classic like home fixes or home remedies is smoke a cigarette and drink a cup of black coffee and that can restore motility. All those things input. So think of it as, you know, a tug of war where you have multiple ropes attached rather than one thing that causes it. I think I've seen online before recommendations.

Can you make Senna into a tea? Sina bedtime tea is a very common thing to take. Does that help? It helps, but it doesn't necessarily address the root cause. A lot of people that have inflammatory bowel, even if it's not overt inflammatory bowel disease, also have good luck with something called LDN. LDN is actually also an obesity medicine when combined with buproprion, but LDN is low dose nitrexone.

And that also kind of has the opposite effect of low paramide. So it helps the gut organize its peristolsis again, but without being a laxative. I would love to learn more about probiotics. And, you know, I feel like everyone's being thrown in a probiotic. And from my understanding, and kind of like you were briefly mentioning to me, too, a lot of the probiotics on the market, and by the time you actually consume them or get them in your hands, they're supposed to be living organisms and they're typically dead. So what's your opinion on the probiotic market?

Do they work? Can they help? if so, are there certain strains you should be looking for instead of just like, because I think a lot of people think probiotic, it's just like generic. I'm taking a probiotic, but there's actually strains, specific strains in those products that we're taking. Yeah, your general probiotic that you get over the counter

probably doesn't have any live probiotic in it. And if it does, it's unlikely that live probiotic will get to your gut. I believe over 90% of probiotics that you just go to target and get over the counter is not going to actually exceed your gut with probiotic. And even if it does, it is very, unless you have a lifestyle change, for example, you are consuming different prebiotics or different foods or even start exercising, it's less likely that you will be permanently colonized with that bacterial strain.

There are exceptions to that and there are ways to get around that. But there's a couple ways that you can take probiotics that are slightly better. The best way is in foods. So things like kombucha, things like kefir. Kiefer is a type of like essentially very fermented yogurt kind of combined with milk. That's a good one. Nato, I believe is a good one. Kimchi is a great natural probiotic.

And then incorporating good prebiotic foods into your diet. Examples of that would be a lot of root vegetables, garlic, leek, onions, chikery root. Those are good sources. In general, I don't recommend taking really high doses of one specific prebiotic fiber, like really high doses of cillium. Cillium can help with the growth of a strain called acrimandia, which can be a good strain for some people to take. But taking very high doses can cause overgrowth of that and paradoxical gut symptoms. And also a lot of cillium has artificial sugars and dyes and flavorings in it, which is not always bad.

But in very high quantities routinely, that's not something that's ideal addressing the root cause. So that's kind of the first best way is incorporating things in the diet. The second thing that you can do is look for spore-based probiotics. Those are more likely to survive the transit to the gut, or things that are syn biotics, especially if they're encapsulated with a specific delivery mechanism, of which there is many good go-toes, but not many of them you can find at target.

Going back to Cillium, Sillium husk, how much is too much? And are you recommending that that's a product or a powder you shouldn't take on a daily basis? taking a small amount is certainly okay in a daily basis, but in general, you can get most the benefit from probably one gram of cillium. And by the way, the powder, when they actually powder it up, is generally better tolerated. But you can combine it with other varieties of bacteria. When you look at cillium, you can see it grows very specific varieties of micropylia.

Acromancea is just one of them. So think of that as fish food for a certain amount of fish. your gut is like your combined aquarium terrarium. Prebiotics are like the fish food you put in. And if you have a broad spectrum of fish that you're trying to facilitate growth within your aquarium, you want to feed all of them their same fish food and not in too high of quantities. Otherwise, you'll have rotten fish food. You'll have other fish that are scavenging that fish food that you don't want to happen. A rib and a glycan may have mispronounce that.

That's another good broad spectrum prebiotic fiber. L-methylulose is another one. And there's a lot of different brands. One of them is called paleo fiber, but there's many different brands that have this broad spectrum prebiotic that you can take in order to facilitate growth with

a wide variety of fishes. That's going to be superior than just megadocin cillium. There's a cereal that I consume every once in a while. I'm feeling a little slow and backed up. I'm trying to increase motility. And it's like a brand cereal

and it's got a lot of cillium in it. I think in one serving, it's like a 40 gram serving. There's 17 grams of fiber. And I make sure I weigh that out too because I'm not taking a chance of getting a chance of getting like 30 grams of fiber. But as soon as I consume that cereal,

I can feel like, I mean, you can hear your gut and making noises. And you mentioned fish food. It actually looks like the pellets in fish food. But there was a time where I was consuming that every single day. And, you know, it started off great. I was feeling better and then I made things worse. So now... It actually induces CBO. Yeah, I was getting super bloated, super gassy. So now that's one of those cereals that I'll have every once in a while. And sometimes it's even half a serving.

But, like, I found that I was consuming it every day. It just made matters worse. Yeah. A lot of times more of one thing is not better. The dose makes the poison, whether it's your food or your medication or your supplement. Even things like water, if you consume enough, then it begins to have negative effects. Do you think one of the best things we can do in terms of diet is diversity of? So, like, I think a lot of us, including myself, creatures of habit, my first three to four meals a day are pretty typically the same thing. And then dinner is what's different.

Do you actively try and recommend people switch up their meals every single day to get more diversity? Some of their meals, certainly yes, but it's not essential to switch up your meals just for the sake of switching them up. It depends on how high quality of a meal it is. So let's say every day for lunch or breakfast or whatnot, you have, you put some salmon in an air fryer and you eat that along with a rotating vegetable source and a rotating carbohydrate source. That's pretty reasonable. Or if it's breakfast, even without a carbohydrate, if you're not going to leverage. training immediately and not need that carbohydrate benefit. But in general, and again, I've already

shouted out my friend Diana with Nguyen with Nutrition. She says that one of her main goals as a dietitian is to allow people to be the least restrictive possible, which is contrary to a lot of nutritionists and dietitians where you're just eating the exact same thing all the time, where you're able to eat very small amounts of something that you like and not overconsume that thing. So it's not as sexy as, you know, saying, always avoid this or eat this at very high quantities all the time, but it's best for the patient.

Right. I'd love to kind of shift over into some more exercise, specific information right now. and I'd love to hear your opinion on how much is too much training in terms of strength and endurance. And we'll start there. Like an optimized training program, a split between cardiovascular training and resistance training. What is your approach? What is your recommendation?

This can vary to some degree because there is a lot of crossover between aerobic training and resistance training. If you're doing things like high-intensity interval training or CrossFit-type training, then you're not going to be able to do that and then also do a whole bunch of Zone 2 and Zone 3 cardio for, you know, 300, and this is for the average person. There's obviously exceptions for 300 minutes a week and then also do heavy resistance training five days a week. So you have to pick that balance, depending on what the individual likes, kind of similar to diet. diet. Let's say they really like resistance training, then doing resistance training, five or even six days a week, and then partitioning their cardio into mostly low zone two or even high zone one

or two or three days a week, 30 to 60 minutes per time. That would be very reasonable. If an individual really likes cardio or let's say they like running, then hopefully they can do some cross-training like rowing or swimming or biking. But let's say they do that five or six times a week and then do resistance training just two to three times a week. What does the impact? I've always been curious to this. What is the impact on endurance training on hormones?

Because for my personal experience, I don't know if it's because of the direct relation between endurance training and crashing my hormones or if it's that I'm overtraining or there's too much volume and it's affecting my hormones. I always find when I go into a big endurance training block, it has an effect on my testosterone. And I'm curious is, is that something I'm doing wrong or is that just the name of the game?

Yeah. It's not something that you're doing wrong. It is the name of the game. I agree with Ryan Hall here. I know he, and he was a marathoner for people that don't know. Actually, they probably do know if they're listening to your podcast. I had him on the podcast before. So they're probably very familiar.

And I agree with him. If you're an elite marathoner, then there is no way that you're going to get around that affecting your hormones. Hopefully you're just genetically elite with being resilient and just pumping out testosterone and growth hormone, regardless of the overtraining and regardless of the high mileage. However, that being said, for the average runner, it's probably not affecting things. So I actually ran track for a while. I did mostly 800 and 400. And if your mileage is not extremely high week per week, then it's much less likely to affect your optimal hormone profiles. Perhaps you take a bit of a hit, especially when you're in a phase of the season where you're training very regularly. And then when you delode, you recover some of that. Is there any way around that? And I'm sure it's dose dependent. Whereas, you know, mileage gets higher, yes, it's going to have effect.

So, like, one of the ways around it is don't get mileage above a certain point. But is there something that you can do in terms of diet? Can you incorporate more dietary fat to avoid some of that? Can you sleep more to avoid some of that? Is there anything you can do? Because, clear example, I'm about to go into another ultra. prep in the next couple weeks. I'm doing a last man standing ultra in September. And I'm hoping that I can just like maintain hormone health to that prep. And a reason I'm not

taking my miles to the absolute extremes during this prep is because I don't want to feel like garbage during it. Is there anything that I can do or people can do to avoid some these issues? There's a lot that you can do. As you mentioned, more sleep helps. I think there's some evidence, mostly anecdotal that taking a lot of naps will help, especially early on of the day, if you're an elite athlete and you're running a lot. Also, as you mentioned, to some degree, consuming more fat and micronutrients will help. That's one of the benefits of being a runner, is you can likely consume a lot of calories and not gain too much body fat because you're also burning a lot of calories. So eating very nutrient-dense foods, limiting things like alcohol,

there's an interesting correlation between elite runners and elite swimmers. They consume, I think it's three or four times as much alcohol as the average individual. Oh, wow. And part of that's just because alcohol is seven calories per gram, whereas fats nine and protein and carbs are four. So alcohol is a great source of caloric density. So your body very well may crave alcohol along with fat as replenishing the calories that you've burnt and trying to prevent you from going into a caloric deficit. That being said, the alcohol, Alcohol is going to up regular aromatase and increase estrogen and decrease testosterone. And also it's not a very, you know, it's not going to have vitamins in it.

So it's not a nutrient dense source of calories. And then on top of that, of course, you know, you finish a race. And I would do the same thing, you want to drink beer or drink something because you have that immediate euphoric effect. And it works better too for its, I guess, socially therapeutic benefit. Right. What's happening in the body that is causing a decrease in males, for example, decreased testosterone with increase in endurance training?

Is it that your body is trying to become more efficient and lose mass and size so it, you know, it's regulating hormones to facilitate that? Part of it is hypothalamic and pituitary dysfunction, so it's likely, and I don't remember what your LH and FSAH were. They're always low. So low LH and low FSAH can be secondary to what's called feedback inhibition at the pituitary. And it can also be due to the hypothalamus. The hypothalamus has several inputs to make GNRH, which is genetropin releasing hormone.

GNRH is just the hormone that comes from the hypothalamus up in the brain, down a little bit further down in the brainstem to the pituitary. I think Descartes was a philosopher that thought the soul was in the pituitary. Unfortunately, it didn't turn out to be a true hypothesis. But LH and FSAH are released from the pituitary, and they go to the gonads, ovaries, and testes respectively. And that's what causes the release of testosterone and the release of several other hormones as well. However, even the LH and FSA that is released, a lot of individuals that run or train a lot,

they also have oxidative stress that's increased, and they also have heat damage. and the testes do not work as well. Ladig cells are the cells that LH primarily binds to and causes testosterone synthesis and release. So you're not even getting good bang for your buck for the low amount of LH and FSAH you do have. So it's a bit of a combination of what we call primary dysfunction and secondary dysfunction.

Is it directly the pituitary that affects LH and FSAH? Hypothalamus, pituitary, and testes. Interestingly, there are cells in your limbic system, which is the emotional system of your brain, for example, the amygdala, the hippocampus, and those release a peptide called kisspeptin, and downstream to that, that binds in the hypothalamus. So that's one way that the actual physical and mental stress likely affects downstream, causing lower LH and FSAH as well. Another thing to take into account is

prolactin. So higher states of estrogen can increase prolactin, but there's a lot of barramonal or psychosocial interactions on prolactin as well. There's a gene called a PRL gene, and its activity is increased in states of higher estrogen. But for example, if you have a spouse that has a newborn baby and they're lactating and you're around them, then your prolactin will also increase, whereas if you were not around them, your prolactin would not be as high. I've heard about that. I thought that was a myth. That's accurate. It is, so that's where the difference between causation and correlation comes apart. Okay. So it's like, well, is that causatory? We don't know exactly how it would be other than perhaps changes in oxytocin.

But we know that pheromonally, you're going to have a lot of changes in your limbic system. So I think one of the changes that you get is an effect on prolactin, not just an effect on Cispeptin in your Olympic system. Okay. Yeah, but it's correlation. It's not causation at this point. But the effect is persistent enough to where, you know, that is something that you should take into account any male or female, for that matter, that is feeling differently in the

postpartum state, it is very reasonable to check hormones. I remember when I was in college, there were these guys talking about buying and selling pheromones. And they were talking about spraying pheromones on them before going to the bar. And it was supposed to attract women based off of these certain sense. Sex panther clone. Is there any validity behind that? Perhaps oxytocin. If you consider that, not really a pheromone.

that I know of, there's not validity of like using pheromone clones to attract women. Yeah. But if you are attracted to somebody, then oxytocin will definitely help spark things. So interestingly, and this is somewhat different for men and women, and it's not fully elucid and understood well. But oxytocin is thought of as the monogamy hormone for females, whereas vasopressin is thought of the monogamy hormone or neurotransmitter. in males, whereas vasopressin is also thought of, like, antidiarrotic hormone. So there is some differences in hormone signaling to, like, induce monogamy, and the hormones to induce libido.

Well, the next pillars I'd love to dive into are sleep and sunlight and the relation between the two. do you find that most people aren't sleeping enough and to give some context I sleep about six and a half hours a night I would like to get to eight but based off the time my daughter's waking up right now and not going back to sleep

that's just not happening and then kind of a question based off of that as well how does sunlight and regulating circadian rhythm affect our sleep? cycles and sleep performance. So circadian rhythm, that's just the natural rhythm in, well, one, the pineal gland, which is a small gland in the middle of the brain.

The Egyptians called it the third eye. But the pineal gland is inactivated by light going down the optic nerve. And different wavelengths of light are going to inactivate it more. For example, a blue wavelength of light, that's going to be very inhibitory. and I don't advocate for wearing blue blocking glasses except maybe the last hour of the day, although I'm not entirely sure about that either, but that could be reasonable if you're going to wear them last hour.

Whereas a red wavelength of light, 670 nanometers, I believe, has other benefits for the mitochondria of the retina. But that's the pineal gland, and that regulates melatonin release. So melatonin is actually related to serotonin, and serotonin is also loosely correlated with, estrogenic activity. So if you have particularly low estrogen, like a lot of runners do and like a lot

of natural bodybuilders do, then that can interfere with serotonergic signaling. The melatonin is usually high in the evening, hopefully high in the evening and low in the morning. Really high doses of vitamin D might affect melatonin signaling. So it might be reasonable to take your vitamin D in the morning if you think that's affecting your melatonin signaling. Melatonin also decreased. during andropause and menopause, like other hormones. Especially if you have a calcified pineal gland, and I don't think there's much validity to pineal decalcification as far as improving your circadian rhythm.

Cortisol is another main hormone with the circadian rhythm. Testosterone actually kind of has a circadian rhythm as well. More similar to cortisol to where it's high, very early on in the morning, late in the evening, late during the sleep process, and then it decreases throughout the day and is lowest in the evening. So more cortisol is not always bad. If you have deficient cortisol, that's Addison's disease, like what John F. Kennedy had,

where cortisol essentially kind of helps you get that swift kick in the butt, that impetus to get out of bed. Is there a certain time of the day that's most beneficial to get sunlight? I know a lot of people, like Huberman talks about as soon as you wake up, go get some sunlight. Does it matter if you get it in the morning or throughout the day or just getting it at some point? point? The first half the day is the most important. The more your sleep is disregulated, the more important it is to get it earlier in the day. For example, during a time zone shift or if you have jet lag, that's particularly important. And if you are going to shift a whole bunch of time zones, that's when it's most reasonable to take a little bit of melatonin,

depending on how fast you metabolize it, one to five milligrams, or even a melatonin receptor agonist, like Rosarim, which is a generic melatonin receptor at its first and second receptors. It's third, receptor does have a lot of, a little bit of hormonal interplay. So perhaps in pediatric populations, watch the dose if you're taking it all the time. But it's not a significant interplay to be very concerned with. Sunlight later in the day can help. There is validity to low solar angles, like Huberman likes to say. But if you don't have a sleep disorder, you don't have to incorporate low solar angle sunlight into your routine every single morning. What's your opinion? on red light therapy, like those infrared juve lights, for example. Are those beneficial? And do they

help regulate circadian rhythm? They can. It's not a necessity. It's nice that it does not have full spectrum bright blue light that's getting into your eyes in the evening. So that's definitely one, like if that's, that's like the opportunity cost. If you're getting red light, then hopefully you're not getting really bright light right before you go to sleep. I mentioned the 600 170 nanometer light that can be beneficial for the mitochondria and the retina and theoretically in other areas of the body as well. I'm skeptical about its use specifically for basically transluminating the scrotum. So I'm skeptical for its benefit for testicular health. With a lot of the patients that you're working with, how do you approach these pillars of health being sunlight and sleep? What are your recommendations? What are your typical protocols, how do you incorporate these into the patient's lifestyle?

For the average individual, about seven to eight hours of sleep per night, if they feel that they may have a sleep pathology, I have a very low threshold for ordering a sleep study. There are certainly sleep disorders other than obstructive sleep apnea. And even if you do have some sleep apnea, there's a lot of things that you can do other than wear a CPAP mask that's suffocating you. So, and then as far as the sunlight, getting outdoors and getting light, hopefully the first half the day. The Pareto principle is certainly true. So law diminishing returns, the first 20% of light and outdoor time you have, the better. One thing that I noticed a huge, it made a huge difference in residency, whether I was doing a night shift or a day shift or whatnot, is I live close enough to the hospital.

I would long board the hospital. and it's not just the sunlight that I noticed. Sometimes it was dark too when I wrote in. But you also have air in your face and you feel the cold air. I don't know if there's like a huge benefit to grounding. Some people certainly do great. That's like when they go outside barefoot and do prayer meditation. And for some people that can work well as part of their sunlight and outdoor therapy,

one other thing that can be beneficial is seeing things that are green. So outside of sunlight, if you have more trees and more green plants, even if it's not right around where you work, but outside a window where you're working at, you're more productive and in general happier. And then in addition, having your hands in the ground. So I think we both share desire to have a big garden. And I like working in the garden with my family,

but that does have health benefits as well, even if you just do it once or twice a week. There's a massive difference between mornings where I wake up and I go run outside and when I don't. And 90% of my mornings, I'm running outside. I start my run when it's still dark. As I'm finishing that run, the sun is coming up. I see trees.

I see green. My shirt's off. I can feel the air. I think I'm waking up with the world. The way that I feel in those first couple hours of the day and the remainder of the day, is completely different from days when I don't run. And that's why now, even if I don't have a run that I'm going to do, I'll just go run the dog for a mile or two.

Because it makes such a big difference. I used to always think it was just mental. But from, in your opinion, are there actual physical adaptations that are changing that will shift your mood and energy for the remainder of the day? Yeah, certainly so. So from multiple different systems, It probably does help shut off that light switch in the pineal gland to really say melatonin,

we don't need any more of it. And then it also helps basically acclimate your adrenergic system. So you have your sympathetic system, that's your fight or flight, and you have your parasympathetic. That's rest and digest. And you have hormones like norapinephrine, which is noradrenaline, which is noradrenaline, and adrenaline itself, and dopamine. And those can help be kickstarted by being outside or a run in the morning. Just not exactly the same, but similarly to how timing your caffeine or your coffee,

let's say you time that an hour or an hour and a half after that helps you dump your adenosine, take care of that, and then also get a concurrent cortisol spike. The next thing I wanted to ask about, there's last like four to five weeks of my bodybuilding prep. I could not make it through a night of sleep. And I'm sure just being hungry was part of it. from the night hungry, but I would go every hour and a half, every two hours, waking up, rolling around in bed, I go to the bathroom, I was going to the bathroom every hour to hour and a half. It's part of that inability to sleep hormone regulation.

Certainly. So in the hypothalamus you have, and this is like independent of the effects of ghrelin. Grelin can increase when you're particularly hungry, and that has an effect, in the pituitary and the hypothalamus as well, it actually can help stimulate growth hormone production. But outside of that, you have your two main centers. You have your anaerexogenic center, and that's kind of like exactly what it sounds like. You're not hungry, you're satiated, and you're tired.

You just kind of feel like you want to sleep all the time. Then you have your orexogenic center. I called this the hangary center because you're hungry, you're awake, and you're agitated and angry as well. And there's two different receptors for orexin. Orexin activates the orexogenic center. And this is hyperactive, of course, when you're essentially purposely starving yourself

during a bodybuilding prep. And there's actually orexin antagonist. So there's one orexin inhibitor that just inhibits one of the orexins. And there's two different dual orexin inhibitors. And these are non-trankalizing sleep medications. and they can be particularly helpful for bodybuilders in prep or just for the individual that has a hyperactive ororexigenic center. Often when you're in a caloric deficit,

you do see the quality of sleep drop off. Yeah, mine was absolute garbage for those last couple weeks. And now it's one of the things I was most excited about, that prep being done, I just wanted to make it through a night of sleep again. Because that, for me, it wrecks you for the day. I would start getting nervous as the sun was coming down. It was getting dark.

I knew sleep was coming up and I knew I couldn't sleep. Yeah. So I had like trauma from that experience. Yeah. No, it can definitely be very concerning. And that's one of the difficult things with orexin inhibitors is their non-tranclizer. So a lot of medicines like Lunesta or Ambien or Gabbaergic or Benzos will knock you out. And there's that feedback inhibition.

that that's the only thing that works and you have to have that for it to work. And then other medications, like let's say you took a dual orexon inhibitor for six or eight weeks. You want to start it before you really need it. And then it kind of seems like it doesn't work at all. And then your sleep does get a little bit worse, but it's much, much better than it would have been. Right. Well, the next pillar I want to talk about is stress. I think most people would assume that you want to limit stress as much as possible in your life.

but you also mentioned that you need cortisol. We want some sort of level of cortisol in our life. We need it. Why is stress one of the health pillars and from what angle? Yeah. I mentioned that you want effort to feel good, regardless of that effort is lifting a very heavy weight. If that effort is trying to get a toddler dressed for Sunday school in the morning,

you want both of those things to feel good. so you want to teach yourself in order to enjoy that stress. Now, in general, higher levels of stress, at least in animal models, you look at both dogs and wolf packs. The lead pack, so the alpha wolf, tends to have the highest level of cortisol, but not the highest level of testosterone. Interesting. Some animal scientist joke, and it's all the female wolf serve. dogs that he has to look after that's increasing his stress. So I think that's kind of funny as well. So higher stress and being able to handle that stress is certainly a good thing. And I think

individuals like Cameron Haynes and Huberman and David Goggins and others are good examples of having what you would think would be very stressful lives, but adapting very well to that. So is that a muscle that can be trained? Is that an adaptation that with more stress we add we get better at or is that something we are genetically born with and it's in our DNA? It's also both in this situation and sometimes I joke that the answer to everything is it depends, but fortunately with long-form podcasts, we have some time to explain why it depends. I was joking with my colleague and good friend James O'Hara. He's a nurse practitioner that I do podcast with and the co-host of my Gillette Health podcast and he was looking at his SNPs and one of them and he is the most even keeled

best handling stress person that I know, and he's particularly analytical, and he, you know, he could be in a code, and he would be calm, just like your Army Ranger. One of his SNIP said, more prone to anxiety and dysregulated levels of stress. So he's obviously learned to account for that, or perhaps he has other genes that kind of like do the other thing. So there's no great, strict genetic correlation between, you know, you have stress or you're not going to be able to handle your stress well or you are. But you definitely see it's kind of passed down in families. But in that family, is that more nature or is that more nurture like we were talking about earlier? My toddler's watching my wife and I get ready for vacation. They're picking up all of

those habits. If we get stressed during that time or if we're worried about something, then they start to exhibit those same actions. Is it learned through? behavior and observation. I think it's mostly learned. And it's like anything else. If you want to get to a high level of stress, then you don't start doing that right away. You use progressive overload.

So that's why if people, once you progress to lifting a very heavy weight, you're adding tiny little plates, maybe 2.5 pound plates or five pound plates at a time and going up very slowly and then having periods of relaxation and rest. Going up very slowly, having periods of relaxation and rest,

and you do the same thing with stressors in your life. And so you talk to entrepreneurs, business owners, or like year one, the smallest amount of stress and change will make the biggest splash, the biggest impact. You look to that same person 10 years later

and they can handle, I mean, chaos and catastrophe and damage and destruction beyond imaginable. So you just get better, at, you know, dealing with that stressor. That's one of the interesting thing about business owners and entrepreneurs from that side of not just hormone optimization, but from lifestyle habits that they have developed is often they're quite good, but not necessarily, because there's a selection bias.

The ones that have made it 10 years down the road, they will think that the way that they did it has to be the correct way just because they survived. And in a lot of cases, that true, but it doesn't necessarily mean that adapting what they do is going to be beneficial in everyone's life. Right. No, I agree with that 100%. Let's talk about spirit. What does spirit mean to you? And how is that, why is that a pillar of health? To me personally, I can, like, I'm spiritual. I'm a Christian. I believe in God. I'm not particularly religious. But that just means your metaphysical being. So in med school and residency, people are actually very familiar with this because we do a lot of end-of-life care, people that are very sick in the hospital. And often their spiritual health, the reason why they're here on Maslow's hierarchy of needs, that's called self-actualization at the top of the pyramid, that's the only thing that matters to them because their physical health is failing and their mental health might also be failing. Conversely, you see cases of individuals who are in an existential crisis. So basically, they don't know why they're here on earth, perhaps they're happily nihilist. And they say there is literally no reason,

but it's like karma, even saying, you know, there's no reason why I'm here. If you are very sure of that with in and of yourself, that starts to become the reason why you're here. Is you like to tell other people that you're a nihilist or you at least like to tell yourself that reason, and that is a reason. So just understanding what that reason is for you, even if it's literally nothing, it's a joke and it's a meme, then that can bring some sort of balance to your life to where that's not going to cascade and domino and disregard your mental health or your physical health.

I'm listening slash reading a book right now. I believe it's called The Courage to be disliked. And it kind of explains those concepts of finding happiness but actual happiness and the story you kind of alluded to was very similar to the chapter of the book that I just listened to. I would love for you to explain, and you said you believe in God, you're a Christian, but not necessarily religious. Can you explain the difference in what that means to you?

Yeah, so at the end of the day, you have to think to yourself partly analytically and also partly, like, regardless of what you want to believe, you may believe something or you may not believe something. So what you want to believe is not always what you actually believe. So to me, the, like, excess religion is an adulteration of the way that the human feels like we got here. So, again, at the end of the day, you believe in. maybe artificial intelligence created us, but then who made artificial intelligence? Perhaps ancient aliens, perhaps it was a process.

It was completely evolution. Perhaps it was partly evolution. Perhaps it was a natural intelligence. That's the way I'd see God is just a natural intelligence. And to me, logically, believing in a natural intelligence is easier than believing that and artificial intelligence designed things, and also easier than believing that things purely happen by chance. Everybody can have a different reason and have good spiritual health.

We won't know, and we'll probably never have a way to scientifically prove, like exactly why we're here and how we're here. But what I do know is that at least addressing that and being okay with talking about it, just like we're okay talking about mental health and sexual health and all other aspects of health, I think it should be okay to talk about spiritual health without a huge stigma or without people saying, you know, like you're a scientist or you're a doctor, you shouldn't be talking about spirituality. On the contrary, I think it is vitally important. You see that a lot of times where like as soon as someone starts talking about spiritual health,

it's, I'll write this guy off. I mean, it's mostly you lose all your credibility of what you just gained. Have you found that with a lot of patients, people who haven't had some sort of spiritual health and then have introduced and incorporated and truly believed in something that it has changed their health and wellness? Yeah, some people seem to enter this state. Again, I'd consider it existential crisis, for lack of a better term, where they're trying to figure out what group. or what belief system they have.

And sometimes it's extremely hard to believe. And one thing in anything, whether it's pure chance, artificial intelligence, natural intelligence, whatnot. But know that doubt is common and it's okay to doubt. Also know that it's okay to change your mind multiple times. So this is the six pillars of health.

And I'm sure we could spend days and weeks on those, and I'm sure you actually have, because it's the foundation of your practice. But I would really love to focus now on optimizing hormones. And, you know, I was talking to my wife about this, because this is something I'm very interested in, passionate about, and I want to learn more. And when I naturally think of optimizing hormones, I think of my total testosterone, my free testosterone, LH, FSH, SHBG,

and my wife was talking to me and she's like, well, there's another part of the population, women who are focused on another part of the, you know, their hormone system. So I guess to start kind of generally speaking, what are the differences that you're looking for in men and women when you're trying to optimize hormones?

What hormones are you trying to optimize in women? What hormones are you trying to optimize in women? What hormones are you trying to optimize? in men to make the biggest impact. It's all the same hormones. It's just at different ratios and at different cyclical times if it's a female. And to some degree, if it's a male, if you're looking at like time over their life, optimal hormone profile for a 15-year-old is certainly different than for an 80-year-old.

But that being said, another thing to keep in mind is in females, menopause has, if you live long enough, there's a 100% chance likelihood that you will go through menopause, which I consider a pathology. And there is also a very high likelihood that at some point in your life you will desire contraception. And most contraceptive options are essentially synthetic hormone replacement. Many people know that I have extremely passionate about synthetic hormones, whether it's estrogens, progestogens, or androgens. So if a provider is not comfortable providing hormone replacement therapy, then you probably should not

choose that provider to manage your synthetic hormone replacement therapy, aka your contraception, whether it's the implant, whether it's an IUD, whether it's an oral contraceptive pill. So with that caveat out of the way, the main hormones to manage would be testosterone, estrogen, and by the way, even in females, most females have four times the amount of circulating testosterone

as estrogen. Estrogen is in picagrams per mill. So let's say your esteridyl is 100 and your total testosterone is 40. Your total testosterone in pica grams per mill is actually 400 compared to 100. And testosterone does aromatized estrogen. So testosterone is certainly a female hormone and estrogen is certainly a male hormone. The more estrogen a male has, the more they are protected against plaque buildup and cardiovascular disease.

why you look at men that have very low both testosterone and estrogen. When you replace the testosterone, you're also replacing estrogen and their risk of developing a heart attack goes down. Whereas if you took a male that has a higher level of starting estrogen,

but a similarly low testosterone level, that will not decrease the risk of plaque buildup and heart attack as much. I kind of want to take a step back. Birth control, contraception, how big of an issue is that? that we're experiencing society because of the wrong people prescribing it that don't have the

knowledge and information. It is a very huge issue, especially when it's not prescribed for contraception, because it very seldom addresses the root cause. So it's very common for 12, 13, 14 year old. Emails to come in, they say, I just need a birth control pill. My periods are heavier. My periods are irregular. I have acne.

My two sisters started the same thing. And instead of doing that, you do a workup and run labs and you see significant pathology, whether it's metabolic syndrome or PCOS or, you know, whatever it may be. Conditions like hypothalamic aminorrhea are much more common. That's basically the like low LH, low FSA, but in a female. And that can, it's on a spectrum too. So it can be very mild or very significant. But like I mentioned, I'm a fan of addressing the root cause.

of those pathology. I'm not anti-hormone, certainly, and I'm not anti-synthetic hormone. I have many patients on synthetic hormones. But yeah, that would be my main message. And it's also an issue of supply and demand. Because one of the main health issues, one of the main things that is a benefit in life is deciding when to and when not to conceive a child that can have profound social health implications if you're not. So I definitely am very, very pro availability of contraception, but I'm also very pro education. I am for educating the population about both the benefit and the detriment of contraception. For an individual that desires contraception, it is likely that the benefit of not having to conceive a child at that time far outweighs whatever

are detriments, even if there are many detriments, but they should understand what they are. What are the detriments of, you know, say, because I have a daughter, right? She's only 10 months old. Yeah. But say when my daughter's 13, 14 years old and all of her other friends are getting on birth control and she says,

mom, dad, I want to get on birth control because all my other friends are on birth control and it's going to regulate my menstrual cycle and all these things. What's the con of getting on too early? and staying on for an extended period of time. There are dozens. A lot of them are minor, but several of the ones that you should be familiar with is you will be attracted to different people.

Really? It changes your, yes, you will be attracted to different individuals than you would have otherwise, and then if you come off, it returns back to baseline. You're essentially not having that, for most contraceptives, you're not having that ovulatory spike of estrogen and testosterone, and you're very different pheromotally as well. So if you meet your partner while you're on, you know, birth control and then you get off birth control,

there's a chance that you are not attracted or like your partner. There's certainly a chance. Although there's also that variation even within the menstrual cycle. So women who are ovulating are attracted to different individuals than when they're not ovulating. So it's not the end of the world. and I don't think that in and of itself that is degrading society. That's certainly more multifactorial. And part of that's just societal entropy. But that's important to know that when you go on,

your attraction to different individuals will change and that is due to the contraceptive. Another thing to keep in mind is risk of VTE. That's venous thermal embolism, blood clots in the leg or the lung. That's largely related to the change in platelets in SHBG. Another risk is, depression. So if you look at, by the way, for people that want to deep dive into this synthetic hormones, the Gillette Health podcast has, I think, multiple episodes just on synthetic hormones and oral contraceptives and which ones, for example, Levenorgestrel, which is anandrolone-derived oral contraceptive versus Drosperinone, which is a spronylactone-derived oral contraceptive, which

ones are more likely to cause depressive symptoms or specifically the in-point they looked at is admissions to psychiatric facilities and then being subsequently started on antidepressant or breast cancer. Some have a significantly higher risk of hyperplasia of the breast tissue. And then it's often started for conditions like endometriosis, which is overgrowth of endometrial tissue because it can prevent you from having your period. But it's also a strong estrogen agonist and it can lead to increased IGF1. So IGF1 is going to grow all tissues. likely even endometrial tissue, and estrogen is also going to lead to that as well. Whether it's HRT or synthetic HRT, oral contraceptives, if you do not take an androgen with it,

your free androgen index will also decrease significantly, and that can affect your lean body mass and your body composition. Yeah, I remember when my wife was on birth control when we first started dating. there were times when she would go pick up her prescription and the doctor would just change the medicine completely. It was like this new medicine and she would feel completely different on this new, this completely different medicine

which blew our minds because she was struggling to regulate the way she was feeling based off of what medicine she was being prescribed. Yeah, no, it's pretty surprising. An analogy that I make, mostly mostly humorously, is I wish women would give as much thought to their menstrual cycle as men, as bodybuilders did to their steroid cycle, because a bodybuilding coach would not just randomly change the different compounds that's in a cycle. And conversely, the doctor should also not change those

compounds. If there's a male and they're on a hormone, usually an androgen or a synthetic androgen. They want to know every single thing about that and they want to know its upsides and downsides and they want to find the perfect one. And that's how people should approach oral contraceptives as well. And there should also be no stigma against taking a low amount of an androgen, whether that's DHEA or testosterone or even a synthetic androgen along with an oral contraceptive. For women. Is that pretty common? It's not common, but hopefully I'm helping make it more common. Yeah. Well, I'd love to talk about next hormone replacement therapy, but at what point do you as a doctor prescribe hormone replacement therapy?

As we were previously talking about before we started this podcast, telemedicine has become this phenomenon over the last couple years. And it is easier now than ever to get prescribed hormone replacement therapy. testosterone placement therapy, H-R-T, TRT, T-R-T, and telehealth is just prescribing it like it's skittles out on a vending machine. You as a doctor, at what point do you start saying, okay, now let's start exploring medicine. What options do you exhaust prior to that? There's a false dichotomy between the conventional medicine system

where you go to an endocrinologist, you're a urologist, or a family doctor. And let's say you have a testosterone of 270. They say everything's perfectly normal. Maybe they don't even check it two or three times. And they say don't even come back because everything is fine. And then on the other hand, you have telemedicine clinics. And I don't want to be too negative. I'm still friends with Derek. I was medical director of us. It was telemedicicic for a year and I am all for access to health care treatments. They have a very, and most clinics like that have a very underserved, underinsured patient population, and it's great that they have good access to care. But we know that they almost always get a prescription of a hormone, probably a very short visit,

usually not with an MD or a DO. And they also are often offered multiple other medications in the same visit. And they usually only have one visit with their provider per year. So that's not optimal, but the alternative to it is nothing. So just like safety net clinics in underserved areas, they're areas with high hipsoc scores, but basically those clinics are also known to not be the highest quality of clinic, but they're better than nothing. Also, just because the thesis is not true, it does not mean that the antithesis is true. Care that somewhere in the middle is best, but at this point there's just not enough supply to meet that demand. I'm certainly doing my best.

And I have a lot of programs in the future to help educate healthcare providers after every podcast I do. I have lots of people message me, doctors, nurse practitioners, and they say, how did you get to the point where you are and how can I do it? And it's basically because I tailored my education and did self-study. but I am putting that into a fellowship at some point, which I hope will help. But I guess the direct answer to the question is, yes, if you go to a telemedicine hormone clinic, you will extremely likely leave with the script.

There's a study that was done within the last year or two, and they had what's called a secret shopper go to these clinics. It was a male. He turned in his labs. He had a total testosterone of over 700. And at very few clinics, was he asked if he desires fertility in the near future. and at almost all clinics, if not all clinics, I think all clinics except one recommended testosterone and then one that didn't recommended five or six other medications.

Say a male comes in to work with you and you do blood work. What biomarkers are you looking at in terms of hormone health and at what ranges are you looking for those to be optimal? Total and free testosterone. optimal from a performance standpoint, whether it's cognitive or athletic. Ideally, your total testosterone is 500 or above, and ideally your free testosterone is 12 or above. Estradial and men should be measured not by amino assay. So it should be measured by LCMS, which is liquid comatography with 10MS spec,

or equilibrium dialysis also in its equilibrium ultrafiltration. Amino assays are just not very accurate. for estrogenial, you want that to be about two to three times your free testosterone. So if your free testosterone is 15, then your estradial should be about 30, so 45. But in general, you want your estrogen to be as high as possible without symptoms of too much estrogen, like moodiness or gynecumastia. So in addition to that, I like to check IGF1. That's your best proxy marker for growth hormone.

And I also like to check T-SH, which is thyroid-stimulating hormone. hormone and free T4 and usually free T3 as well. Those are your thyroid hormones, free T3 being your active thyroid hormone. In addition to that, I like to check SHBG, which is sex hormone binding globulin. That's what binds androgens androgens. I also like to check cortisol and progesterone. Interestingly, cortisol and progesterone also share a binding globulin. Almost all hormones have binding globulins. For example, IGF1 has several binding globulents. So almost all hormones have a total hormone and a free hormone, even IGF1, total IGF1, free IGF1, and then hormones all have different receptors as well. So one example for testosterone is testosterone, DHT, DHA sulfate, all

androgens share one androgen receptor. And some people just have a more sensitive receptor and some people are less sensitive. On one extreme end is AIS or androgen insensitivity syndrome. It's where you have an extremely high testosterone. You have your whole life. But you appear phenotypically female because you're completely insensitive to endergens. And then you have people that are hypersensitive to androgens. Oddly enough, a lot of these individuals have an IQ beneath 70 and a lot of like issues secondary to hyperandrogenism, like early prostate cancer.

And then you have everything in between. That's determined by your, mostly by your number of CAG repeats on your androgen receptor itself. It's on the X chromosome. So males only have one X chromosome, and females have two. So whatever number of repeats you have, your androgen sensitivity, you can thank your mother for that. So what determines your ability to build muscle? Is it total testosterone, free testosterone, or is it the sensitivity of your androgen?

Or is it none of that? Is it something else? For men, the primary input, and there's a lot of different vectors, again, it's like a rock and you're pulling it with multiple ropes. For men, the biggest, strongest rope is how much gene transcription or how much the gene is activated, that is the androgen receptor gene. So that does include the sensitivity. You can look at individuals that have insensitivity to androgens, like, you know, 35 repeats, and individuals who are very sensitive to androgens, like 15 repeats. By the way, I think Romania is one of the countries with the most repeats, so the least sensitivity. and Zambia and a few other countries have very few repeats, something like 17 on average.

But individuals with fewer repeats will have more muscle if you look at a population-based level study. Past that, androgen receptor density also matters. So the analogy that I make is the androgen receptor is like the door. The cell is like a house. And then total testosterone, free testosterone, that's going in and about the street, but it has to actually enter the cell.

And then after it's in the cell, there has to be enough receptors that it binds to. Heat shock proteins is what regulates the density of the receptor. Things like tadalophil, carnitine, and even just testosterone itself. And estrogen actually will upregulate the density of the androgen receptor. And heat and cold exposure likely also are going to improve the density of the endrogen receptor. That's the number of doors in the house.

So your androgen walks into the house, it wants to go through the door. let's say your androgen receptor is not very sensitive. It's like a steel core door. If it is sensitive, it's like a hollow core. It's easier to open. Even a weak androgen, like testosterone, which is kind of like a medium strength androgen, can open it. But if you're an individual that has, that is not very sensitive, then you might require something like dh-t to open it. Not so much for the muscle billing benefit, but for the feeling good, the neurologic benefit. That explains part of the individualized response to anti-endrogens like fanastriide and utastoride as well. So hormone replacement therapy, testosterone replacement therapy, isn't always the answer

to increase androgen sensitivity? The androgen sensitivity, like unless we develop a way to do it with CRISPR, you'll never change that number of CAG repeats. If you're a female, you can epigenetically change it between more sensitive and less sensitive. You can change the density. So if you start taking, like if you're deficient in Elkarnatine or, you know, some people start a low dose of tadalophil, that can improve your endergen receptor density. But if you just overload the cell with endergen, then in most individuals that will help. But it's just like anything, law of diminishing returns. We look at

studies that compare no testosterone to 25 milligrams of testosterone per week for men. That's worse. 50 milligrams is about the same, 100 milligrams a week a little bit better, 200 milligrams a week significantly better, but then that effect starts to diminish to some degree after 500 milligrams a week. So more testosterone, especially more free testosterone, does help build muscle, but at some point which is genetically determined, partly due to antigen receptor activation,

partly due to myostatin, which is highly genetic as well, and there's actually a myostatin inhibitor that's going through clinical trials right now. It's not YK11. That's another genetically determined variable. The myostatin inhibitor, in theory, if you take that, you can build more muscle, correct? Especially if you concurrently have higher levels of free androgens and IGF1. Isn't there like a cow that naturally has a lot of myostatin inhibitor and it's those cows are absolutely jacked?

the Belgian blue. So the Belgian blue, um, in utero, it's genetically passed down. You have very low levels of myostatin. So you have significantly more muscle cells, both like actual muscle cells and satellite cells when you're born compared to the other individual. There are a lot of natural myostatin inhibitors. Um, Epicchio gadachin is another one or any epicatachin. Epichatin is a mild myostatin inhibitor through his modulation on phallostatin. Fortatropin is another myostatin inhibitor. They have that for dogs of which my dog is on, and they also have it for humans. It's basically a fertilized egg yolk protein. I think that's another reason why if a pregnant lady eats a lot of, let's say, fertilized duck eggs, like

probably Michael Hearn's wife ate, that could be a reason why a child, like his child, could be born with a particularly good body composition, with slightly less body fat than the average child, and slightly more lean body mass. So there's a lot of natural options that you can do as well. Egg yolks is probably, especially fertilized egg yolks is one of the good ones. But the monoclonal antibody, it's called a magrumab. And maybe it'll turn out, maybe it won't. They just TEDA study released my colleague James O'Hara posted about this on his Instagram. But over the course of about one year, the individuals that took it, they were either pre-diabetic or diabetic. They lost something like 15 to 20 pounds of body fat. Wow. And concurrently

gained almost 10 pounds of lean body mass. One of the first obesity medicine medications, not the only, but one of the first ones in clinical trials that has that dual body recomposition benefit. That's incredible. I mean, for me personally, I'm not opposed to hormone replacement therapy, testosterone replacement therapy in the future. I've experienced lower testosterone, lower free testosterone, lower numbers altogether the past couple years that I attribute a lot to overtraining, stress, lack of sleep, building a business. And I know there's lifestyle changes that I can make prior to using synthetic hormones. Again, not opposed to them in the future, but the reason that I'm not right now, one, I know that there's lifestyle changes I can make, and two, my wife

and I are trying to grow our family, so we want more kids. What are some of the considerations people need to make prior to making the decision to use synthetic hormones that's going to affect their future. You know, you hear you start it now, you're going to be on it for the rest of your life. You start it now. You can't have kids. What are the pros? What are the cons? What do people need to consider before using synthetic hormones? Yeah. It's just like starting any other medication. So you have your scale and you have your balance of benefit and detriment. And you take into account all of those in your specific situation. So there's something called a therapeutic window. And that's basically if they're very even, your therapeutic window is small.

And then your therapeutic window is higher and higher. So you could take an individual who is like a perfect candidate for HRT. By the way, a couple definitions. A lot of hormones are synthetic, even testosterone, which is bioidentical, is made mostly from yams and I believe sometimes soy, but usually from yams. But in general I call the bioidentical hormones, hormones that your body endogenously makes, and synthetic hormones, hormones that your body usually doesn't make. So that's some definitions.

In your specific case, when you're looking at how you can optimize things naturally, you would also have to ask yourself, like, can you change your lifestyle? Because what you do is essentially part of your profession. Can you decrease the amount of ultramarathons you run or the amount of natural bodybuilding shows you do? Because those things are certainly going to be of detriment. there are a lot of things that you can do outside of taking hormone replacement therapy to improve your function, but it's going to be more and more difficult to do so without a tool. Even a small tool like HCG and FSH, those could be very reasonable tools that you can utilize

during periods of caloric deficit or during periods of overtraining so that you feel better without affecting other downstream sequela. How many blood tests should someone do prior to making that decision? Example, someone comes in, gets blood work done. That is a snapshot of their biomarkers in that period of time, and it's not, oh, I need to go get on HRT. Do you wait like three months and then do another series of blood work and then another three months and do a series of blood work? How many series of blood work panels do you do between how much time? at least two, and ideally one of them is at what I call low tide and one at high tide.

So if you're wanting to prevent damage to the beach, you're not just going to look at things at low tide. So you already have a set of biomarkers during high tide right before a bodybuilding show when you're really depleted and also getting poor sleep. Depending on the academic society, most recommend either two or three fasted morning testosterone levels before considering TRT. But if you got two or three the same week that you did last time, they'd all be very similar. So waiting for a time when you're in a bit more of a caloric surplus and you're sleeping a bit better, that'd be more of a low tide level. If you just got those two, it would be reasonable. Do you think that the fitness industry has stigmatized testosterone replacement therapy

because so many people in the fitness space use it as an excuse to get on exogenous hormones, when in reality they're doing a small cycle. You know, what's your opinion on that? Is TRT, quote unquote, steroids? What is the difference? Is it dose dependent? And are the wrong people using actual testosterone replacement therapy? Yeah.

Most people on TRT, it's, like you said, it's essentially an excuse. I actually think that the fitness industry in general has done a decent job of destigmatizing testosterone use because previously it was abused much more often. And now a lot of people who would have previously abused if it was 20 or 30 years ago are now at least under the care of a physician that's looking out for them. So I think that all in all, that's a positive just like, and this isn't a perfect analogy. And obviously, I'm not trying to equate the use of androgen with the use of opioids or smoking, but in the last 40 or 50 years, there's also been public health programs to help more

people stop using nicotine and use alternatives, like Tapex is one of my favorite, which is a nicotine receptor agonist. But there's other alternatives as well. Or help people get off of opioids like oxycodone and switch them to buprenorphin or even totally get them off and switch them to LDN. There's a lot of options there as well. So it's better that they, are not getting them from, you know, dangerous sources. And a lot of people who had previously have self-administered TRT, a lot of them do need it, and the benefit outweighs the risk in that individual.

But it's hard to say for everybody. So you think it's the widespread knowledge and accessibility to, your, TRT, HRT, that's kind of closed down part of the black market. of what used to exist in the industry years ago. Yeah, I think it's fantastic. And I think if they shut it down, then it would remind me of prohibition. So you're in prohibition,

people found ways to drink, and it was dangerous, and it led to other negatives because it was taken off the market. Prohibition, of course, the prohibition of alcohol. So I certainly think that we shouldn't scale back the availability of HRT for men or for women,

but we should educate both the patient population and providers on how to do it in the best way for the patient possible. Yeah, I've spent a lot of time doing my personal research and just trying to understand and learn pros and cons, and especially based off my blood work, you know, my blood work comes back, my SHBG is skyrocketed, my LHFSA8, total free testosterone is tanked to the bottom. I'm trying to figure out the difference between the two. I was recently reading that supplementation with boron can help lower SHBG. I don't know your

thoughts on that, but I'm looking for all these weights to give my hormones back in range, not necessarily to change my body composition or improve performance, but just add vitality back to my life. And I'm curious your thoughts. or experience with people who come into your clinic and are under your care, how many people are just trying to get back into range and feel better for their lifestyle, show up for their family, their job, their kids, as opposed to performance? Most individuals would be in the former category, and even the individuals who are primarily seeking after some sort of HRT for performance benefit,

often do so because that's the job or profession that they've chosen. So it's interesting in our society that there is such a stigma against doing things that are going to improve the performance in your profession. If you look at a lot of other countries like China, then they openly support basically anything that they can get away with in order to take the child or the young individual and make them better at their profession, the best in the world. So I think that it is a very noble pursuit to try to be the best in the world. Now, if your profession is in, say, like a drug tested federation, then obviously you shouldn't do anything that's against the rules there. But most individuals are in it because they want to improve

what I'd call their health span, not necessarily their lifespan. Perhaps they've seen someone in their family go through hormone dysfunction or maybe they've seen their mom go through menopause or their dad become, you know, like excess body fat and lose a lot of muscle mass and strength. And they're trying to avoid that. So I think a lot of people want it for altruistic purposes. The issue is that they think all they need is the TRT script. And that's not the case. In fact, I had this conversation very frequently. I had it yesterday with someone as well. And they said, all you need is a doctor or an NP with a license that's willing to prescribe. It's all you need because it's easy to get someone into the range.

It would be easy to take in your specific case to give your TRT to get a lab, get a follow-up, maybe tweak it slightly up or tweak it slightly down, get them nice and even, maybe twice a week or three times a week, and the level would be good and that would be it. However, on the contrary, I think the opposite is true. it's one of the most complicated things to manage because it affects every system throughout the body. So you have to be well versed in multiple organ systems, hematology, lipidology, cardiology,

dermatology even. And if a patient thinks that they're not having any side effects, the patient's not going to volunteer that information. They might be having plaque build up in a coronary artery, and they won't know that for 30 or 40 years. So being able to have like a broad spectrum approach to each patient like that is vital to give the best quality patient care.

So many people are on HRT, both male and female now, that we're not going to be seeing the huge population trends for 20, 30, 40 years down the road. How do you start by finding the right doctor? I mean, the first time I'm thinking of like, well, this is scary. You know, if everyone thinks they can get someone in range, what are the questions people should be asking their doctors to know if it's the right doctor?

There's a couple, I guess, criteria is one, ideally it would be an MD, a DO, or an NP, possibly a PA that works with an MD. And then, two, find a provider that's going to listen to you well and take your goals into account. find someone that is not incentivized to and not paid by selling more medication, selling more supplements. They're paid by the high quality medical advice that they give to you. And then find someone that's not going to be biased by what I call personal anecdote fallacy.

That's the fallacy where they have done a specific thing in their life that has been amazing for them. And they want to apply that to every single individual. For example, the peptide doctor that healed his muscle tear or tendon tear with a peptide. By the way, I have done that. I healed an ad ductor tendon tear with BPC 157, but I don't give that to everybody with a tendon tear. Or, you know, a fertility doctor that has like one specific fertility protocol that here she is recommending to everybody because it worked for them years ago. So those are the main things to look for. However, that being said, another important quality is if they are going to be affordable within your budget, a lot of costs are hidden.

So even if you're only paying a very low amount, only a couple hundred dollars supposedly like a no obligation consult or whatnot, then often the margin or the cost is built into everything else. So knowing what, for example, an average spend would be or knowing what you will spend over a long period of time. For example, if you go through insurance, then you're probably going to spend up to your out-of-pocket max, and even then, things will not be covered very well. For most people, like, when do you recommend people to start getting blood work done? Because I didn't get my first blood work panel done until I was 28 years old. Like, how soon is too soon, or, like, what is the right age to start getting it done on an annual basis? For a baseline panel, just getting labs and not doing anything about them. 18 is reasonable or 20 or very early.

In general, you don't want to get labs unless you're going to have a change in management. However, what a lot of health care providers forget is that change in management might be years down the line. So if you got a comprehensive blood panel on someone who's 20 or 22 and their high level athlete, their total testosterone might be 1,200, their free testosterone might be 30 or 35. compared to, let's say they got that baseline blood panel and their baseline is, even though they're a high-level athlete, a total testosterone of 550 and a free testosterone of 12, then 10 years down the road, they're having some symptoms. Their total testosterone is 350 and their free testosterone is six. Knowing that previous level that they were accustomed to can tell you more about the context

and can change your management because you know that this is their baseline and you would want to get them back to their baseline. So if you were there at some point, you typically can get the body back there by addressing the issue. At least on its normal trajectory. So think of a growth curve in children

where you expect weight and height to increase along a percentile. It's kind of the same way except downhill a little bit. So let's say your total testosterone is 1,000. On average, you expect a decrease of about 5 to 10 nanograms per decal. deciliter total T per year. So 10 years later, then perhaps it's 50 to 100 points lower.

But you would want, so even if they dip down past that, you want to get them back to where they would have already been on their natural trajectory. I'm curious. You know, so you have an 80 or 90-year-old male. What's the highest testosterone you ever seen and so on like that old? Nine hundredths. Wow. Was he just thriving?

Indogynously produced, of course. He was doing well. Oddly enough, he did have some symptoms of higher testosterone, higher dopamine, like premature ejaculation. That tends to be more dopamine, less serotonin. That's why sometimes we do things that increase serotonin to help with that compared to delayed, when it's usually the opposite, lower dopamine, higher serotonin. That's why a lot of SSRIs cause delayed.

Even if it's not pathologic, things are definitely more delayed. But anyway, that's kind of an aside. He did have a lot of other medical things, but that just might be observer bias, since generally people come to see me if they have something going on. So there could be a lot, there likely is a lot of individuals like him that are in general thriving.

He didn't have metabolic syndrome. He didn't have sleep apnea. He was very active. He exercised a lot. He dieted a lot. He slept well. So he had a lot of the pillars of health checked off. So after, like what age typically does it start?

Do hormones start declining? 25 or 30. Okay. And from there, it's just all downhill. Statistically, yes. And just like strength, Andy Galpin talks about how even in older ages, you use it or you lose it. If you use it and you have good diet and good exercise, you can maintain a lot of your strength and body composition into older age.

And that's somewhat true with hormones. but there's also a genetic component and likely an epigenetic component as well where regardless of what you do, some individuals, they nearly inexplicably have very low testosterone, even early in age. That's incredible.

Well, Kyle, I appreciate this conversation, super insightful. And like I was telling you, this is something I've been doing a lot of research on the past couple months because it's something that I'm experiencing and I'm trying to learn how to navigate this next chapter of life

and you know you've been an amazing follow on social all the podcasts you've been on your own podcast super insightful and great info so for the listener highly recommend watching and listening to everything Kyle produces because it's very

informative thank you I appreciate it that's a wrap