Tools for Hormone Optimization in Males | Dr. Kyle Gillett

Welcome to the Huberman Lab podcast where we discuss science and science based tools for everyday life. I'm Andrew Huberman and I'm a professor of neurobiology and ophthalmology at Stanford School of Medicine. Today My guest is Dr. Kyle Gillette. Dr. Kyle Gillette is a dual board certified physician in family medicine and obesity medicine and an expert in hormone optimization. He is an MD that is a medical doctor and he treats patients with a variety of backgrounds and ages and goals. Today we discuss male hormone optimization. We discuss behavioral tools, nutrition based tools, supplement based tools, prescription drug based tools and their interactions in determining overall levels of testosterone free testosterone, dihydrotestosterone, estrogen, growth hormone, thyroid hormone, and many other hormones that impact mood, libido, well being, strength, cognition and various psychological factors. We've covered hormone optimization in both men and women in previous episodes of the Huberman Lab podcast, but today's discussion is different. Dr. Kyle Gillette offers very specific recommendations for people with different goals and of different ages. And we get deep into the weeds of for instance, how does one know whether or not their testosterone is optimized or not, how often to test for specific hormones such as testosterone and other hormones, and really how to gauge how good one should feel. This is something that's often overlooked in discussions about hormone optimization or health optimization of any kind for that matter. For instance, people will talk about reduced libido and discuss whether or not testosterone levels are to blame. But how does one calibrate their libido in the first place? That is, how does one know whether or not their libido is normal, too low or too high? We also discuss, for instance, whether or not hormone optimization should be pursued continually throughout the year. For instance, whether or not you should cycle on and off supplements and or prescription drugs geared towards hormone optimization. And we discuss the behavioral foundations of optimal hormone function. These are things that every male should be doing and various things they should actively avoid if their goal is to have healthy hormones and to quote unquote, optimize their levels of every hormone from growth hormone to testosterone at any stage of life. And while today's discussion is about male hormone optimization, I want to emphasize that we discuss all the various ages for male hormone optimization. So for those of you that are parents, for those of you that are young, those of you that are middle aged or old or teenagers, we explore adolescent puberty, teen and late teens, early adulthood, adulthood, and into the late geriatric ages. So regardless of your age and whether or not you are male or female, today's episode ought to be of interest to you. I should also point out that we will soon also be hosting an expert guest on female Hormone optimization. One thing that I'm certain people of all ages and biological sex will enjoy about today's conversation is that we also get into descriptions of how psychology is and life events impact hormones and how hormones impact our psychology and the way that we show up to various life events. So today is really a broad overview that goes all the way down to fine details about male hormone optimization. And I'm certain that by the end of today's episode you'll have an immense amount of new information about how this endocrine that is Hormone system in your body works and how it interacts with your brain and other tissues and and many, many actionable tools that you can pursue regardless of stage of life. Before we begin, I'd like to emphasize that this podcast is separate from my teaching and research roles at Stanford. It is, however, part of my desire and effort to bring zero cost to consumer information about science and science related tools to the general public. In keeping with that theme, I'd like to thank the sponsors of today's podcast. Our first sponsor is Thesis. Thesis makes custom nootropics and as I've said many times before on this podcast, I am not a fan of the word nootropics because it means smart drugs and frankly, there are no specific neural circuits in the brain or body for being quote unquote smart. Thesis understands this and they've developed custom nootropics that are designed to bring your brain and body into the state that's ideal for what you need to accomplish. They use the highest quality ingredients, things like phosphodidylserine, Alpha gpc, many ingredients that I've talked about before on this podcast and that I happen to use myself. 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Again, that's livemomentous.com huberman and now for my discussion with Dr. Kyle Gillette. Dr. Gillette, great to have you back.

Great to be back. Thank you.

I'd like to begin with a question about one of the most mysterious and important phases of life, which is puberty. I've long wondered whether or not how quickly somebody goes into puberty, so at what age and how long puberty takes, so how brief or protracted that puberty is for them to acquire the so called secondary sexual characteristics, things like hair growth on the face for males, or changes in bone and muscle density and growth, et cetera. When I was in middle school and high school, I noticed that some people transitioned into all that very fast and some people took a long time to acquire those characteristics. Can we learn anything about ourselves, our hormones, and maybe even how long we're going to live based on the time in which we enter puberty and how long it takes us to progress through puberty? I guess that also raises the question, does puberty ever truly end?

There are many takeaways from puberty. Some of the actionable items from it is, yes, it can and does affect your adult height and also stature and also body composition. So puberty is a time and if we're talking specifically about males, think of it as a, a time where if you have obesity as a child, you could potentially use that time to change your lifestyle and habits and reset things. And it is a bit easier. It's almost like a free injection of testosterone and metabolism and drive and effort into your life. There is a wide variation in how quickly puberty goes through, so there's stages called tanner stages, which we don't necessarily need to get into. But if you enter puberty very early, then it can Decrease your adult height or stature.

So for a given male that enters puberty at 13 versus a male that enters puberty at 15, can we say that the guy that entered puberty at 13 is going to be shorter than the guy that entered puberty at 15, or. It's not quite that straightforward.

If they are identical twins and the individual who entered puberty at age 13 also finished puberty, went all the way through the Tanner stages. And if you do a bone scan, which I believe is usually done on the left wrist, and it says yes, your growth plates are mostly closed, you're not going to grow more than a couple inches of height after that.

Okay. Just a related question. When I was growing up, it was thought, or at least people would say, that resistance training, in particular lifting heavy weights, could stunt one's growth. Is that true or false?

It is false when you're talking about just lifting heavy weights. Dirty bulking certainly has the potential to stunt one's growth for two main mechanisms.

Could you define dirty bulking?

So dirty bulking is eating an excess of calories, not just to acquire lean, metabolically active body mass or get stronger, but purposely acquiring body fat.

So purposely acquiring muscle and fat by overeating?

Yes.

And lifting weights can stun one's growth. Do I have that correct?

Correct. So it does two things. If you're doing it as a very young child, it can. That fat can. Can become leptin resistant and it can produce more leptin. And that leptin can activate the hypothalamus, which activates the pituitary, which releases gonadotropins, which basically just increase testosterone and estrogen earlier than it otherwise would have. It's the same mechanism behind why childhood obesity causes early puberty.

Interesting. I do remember a paper published in Science magazine. I believe it was focused mainly on females, but showing that when enough body fat accumulates, the hormone leptin is secreted and that triggers the onset of puberty.

Correct.

Given the increase in childhood obesity that we're observing now, are we seeing an earlier onset of puberty in males and females?

Yes, in both males and females. Not to get too technical, but there's a G protein coupled receptor on the hypothalamus, and leptin directly binds it. So it does appear directly causatory and not just correlation.

Okay, so. And if I understand correctly, what you're saying is for a young guy, let's say 13, 14, who wants to really bulk up and deliberately, deliberately, excuse me, overeats, and is doing their squats and deadlifts and bench presses and really trying to get big. They will get big, but only in the lateral dimension. They're effectively limiting their total height and it can shut down the long bone growth of their limbs. Is that correct?

Correct. The growth of the long bones is mostly related to the estradiol alpha receptor. So basically one of the receptors, estrogen, which can be secondary to early puberty and also is related to body fat because you have that conversion of testosterone to estrogen.

So can we assume that if a young male wants to get into resistance training, that body weight exercises are probably okay, and maybe even some weight training, kettlebells, et cetera, but that they should avoid doing so called dirty bulking, Trying to deliberately gain weight up until what age? Until puberty is over.

I would say an individual should limit the amount of body abnormal body fat accumulation or dirty bulking indefinitely throughout their entire life.

So again, if I understand correctly, that recommendation to avoid deliberate weight gain or rapid weight gain is not just to allow an individual to reach their maximum height, but also to avoid laying down a lot of body fat cells. Correct?

Correct. The balance between that is when you are going through puberty, you are able to add a lot of lean body mass, not just muscle mass, but bone mass and other mass as well.

I started lifting weights when I was 16, and I confess I trained pretty heavy at times. I don't know whether or not I would have been taller than I am now. But when I started that training, I had already reached what was at least close to my predicted height. I can't say that I deliberately waited until I'd grown. It just so happened that I stumbled into the weight room and found that I liked it at age 16, at which point I was already the height that I am now. So in any case, what I'm hearing is that laying down a lot of excess body fat is not a good idea. What if somebody grows up chubby or fat, for whatever reason, reasons related to the eating patterns in their family, maybe even some genetic reasons? Is it safe and or wise for a young person? So let's say somebody who's around the age of puberty or even younger or in their late teens to be dieting and actively trying to lose body fat? Is that safe?

Under the supervision of a physician, it is certainly safe to change your body composition. In pediatric obesity medicine, you're often talking about a recomposition or a renormalization of the growth curve compared to peers.

Great, thank you. So, as you may have sensed, we started chronologically with puberty, and I know that there's another puberty that even precedes the puberty that we're all familiar with. Maybe if you want to just briefly mention that, because I was talking with you about this before we started. The puberty that I'm most familiar with, and I think most people are most familiar with the acquisition of, deepening of the voice, growth of muscle and bone, body hair, acquisition of libido, and things like that. That's actually the second puberty that we all go through. Maybe just mention for us and educate us on the first puberty. I think most people will be hearing this for the very first time.

The first puberty of everyone's life is the first three months of their life. You, you may notice that your baby has more acne the first three months and that they also have, in general, just more changes related to androgens and estrogens, perhaps oilier skin, even more genitourinary, like genital growth during the first three months. And this is mostly due to dhea, which is an adrenal hormone. The second puberty, or the puberty that most people know of, actually starts that same way as well. It's called adrenarche. And it's when the adrenals kick in, I guess, for the second time.

Is there a standard age or age range in which the testicles descend?

In males, usually before birth, it is not uncommon to have one or even two undescended testes, but there is a risk of testicular cancer, especially if they are not fixed early, and also heat damage to the testes.

Well, thank you for that coverage of the two puberties so early in life. I imagine some of our listeners are probably still in one or the. Well, one or the other puberty. The ones that are in the first puberty obviously aren't aware that they're listening to this podcast, but maybe it'll be embedded in their subconscious. But some listeners probably are still in puberty. But I think everyone can remember back to their puberty and roughly when they first entered puberty and how quickly they aggregated the secondary sex characteristics. I'd like to turn now to a general question about what all males ought to do in order to optimize their hormones. So if you could just list off the things that all males should do on a daily basis, weekly basis. I mean, should guys in their teens and twenties be getting their blood work done? Should they be taking supplements? We already talked about weight training. What should they be doing? What should they avoid doing? If the goal is to have a long ARC of healthy hormone optimization.

Throughout the lifespan, there's many things that you should do. An analogy that I often make is when there's a brand new car that comes off the assembly line, you do a full scope of diagnostic workup, hook it up to the computer. And I think we should do the same thing with humans as well. During puberty, obviously you're a functioning human, but I would say there's still development, and I think that the human always develops. I don't think development ever ends. But you wanna monitor that progress across a person's lifespan.

Oh, sorry. So for blood work, I mean, what would be the earliest? Let me put it this way. If blood work didn't cost anything and everyone could get it, when would you want to see everybody get their blood work done for the first time?

Obviously, individuals under the age of 18 should talk with their parents about this. And as long as that the parents and the child kind of agree and the parents are on board with this as well, you can start getting blood work. Often a child will come in with complaints of either precocious puberty or delayed puberty. And this individual might be 9 or this individual might be 15. For a healthy child, when they're going through kind of their later tanner stages, which is 4 and 5, so they've developed several secondary sexual characteristics. They might have hair growth or starting to notice more beard growth. That's a good time to do it. If you're concerned with stature or height, or if you're not tracking along where most members of your family have not just their height and stature, but also the timing of their puberty, then that's time to get lapse.

Right. So if I could travel back in time, I would have gotten my blood work done for hormones and lipids and everything else. At 18, I unfortunately didn't know where and how to get that, and I didn't have any pressing clinical issues. And so I think the first time that I got my blood work done, I was in my late 20s, maybe even my early 30s, and I'm still dying to know what my blood work was when, for instance, I was 17 and I felt a certain way. And I confess that in many dimensions, I actually feel better now at I'll be 47 soon, at 47 than I did in my teens and 20s. And I think it was more on the psychological side. I think that. But in terms of just understanding why we felt great or why we felt or feel terrible or not so great, I think blood work is extremely informative. What do you think are the key things to look for in blood work, I mean, testosterone is always the topic that comes up in the context of male hormone optimization, but certainly there are a lot of other hormones that are important as well.

And with testosterone, you want to get either testosterone and a SHBG or a free testosterone.

Could you define SHBG for our listeners, please?

It is sex hormone binding globulin. It is the protein that binds up all androgens and estrogens in the body. So the stronger the androgen, the stronger it binds. During puberty, strong androgens, especially dht, which is the strongest bioidentical androgen, has a huge role, a prominent role in secondary sexual characteristics. And if your SHBG is very high, then your DHT can run higher because it's not metabolized. But there's not quite as much free dht. So you want to balance between a high enough free DHT and a high enough total dht.

And obviously these blood tests are going to have to be read and interpreted by a qualified physician. Most people aren't going to be in a position to evaluate them properly, or at least not with the full depth that they could if they had an MD like yourself looking at them. Okay, so everyone should get blood work as early as possible, depending on their budget and availability. What should everybody do in terms of monitoring those markers? So assuming that there's no major intervention, how often do you recommend that people get their blood work done?

Let's take an individual who just turned 18, they just got their first set of blood work, they'll probably find something in it that they may want to optimize using shared decision making with their physician. Usually a good follow up is about six months.

Okay, so twice a year getting blood work done and having a physician evaluate it, that sounds reasonable to me. And for those that didn't initiate this at 18, such as myself, I guess the best time to start then would be as soon as possible. In terms of the other things that all males should do, meaning all males of all ages, puberty and beyond should do, what are some of those things? So on a daily basis, maybe you could just take us through the arc of a day and push out some of the protocols that you use or the things that you like to see your male patients use in order to try and optimize their hormone status.

I'll briefly touch on some of the lifestyle pillars to start. Diet and exercise are the first two in puberty. Sleep is particularly important, of course, but with diet and exercise throughout a lifespan, you want to not exclude things that are helping you. For example, during puberty, if you're consuming dairy and then all of a sudden you cut out all dairy, dairy can help increase IGF1 and free IGF1.

And just for our audience, maybe you just mentioned what ig, what having enough IGF one can do for us that's.

Beneficial is it helps you grow, it helps with genital development, secondary sexual characteristics and long bone growth, skin growth, hair growth, a host of things.

So getting an array of nutrients that include dairy, what other sorts of nutrients are important during development?

You want to have adequate vitamin D. Vitamin D helps with testosterone production. It helps again with bone mineralization and stature. After an age of about 25, and there's not a strict cutoff, but up to about an age of 25, optimizing your growth hormone and IGF1 helps with bone density and bone growth. So from the dietary standpoint, you want to have enough free estrogen. Not too much when you're growing, but you want to help basically stockpile bone to prevent a risk of osteoporosis or thin bones fractures.

When you're older or someone who broke his left foot five times while in high school, I can say whatever young people can do to optimize their bone density would be great. That problem seems to have resolved itself over time. But I don't know. Back then I did a short run as a vegetarian, but I've always been an omnivore. I realize that some of this relates to ethics and food allergies and things of that sort. But would you say that, on balance, that most people would benefit from eating a combination of, you know, quality proteins from animal sources and non animal sources, fruits, vegetables and starches? I mean, what do you think, for instance, about people following a pure carnivore or a very pure vegan diet in their 20s and 30s?

In their late 20s, it might be a reasonable option. In early 20s and certainly teens, it is a horrible idea because it is likely to significantly decrease your free androgens, so you will have less testosterone acting on receptors through the body.

Are there any other micronutrients or macronutrients that people in their 20s and 30s should emphasize?

We haven't really touched on fatty acids or fiber. Too much fiber is going to be paramount in kind of like setting your set point of your gut microbiome the rest of your life. There is prebiotic fiber, which you could think of as fish food for your good gut microbiome. Your gut microbiome is kind of like an aquarium or A fish tank?

No, I'm just thinking about goldfish swimming around in that. The goldfish eating. People don't eat goldfish. People live or dead.

Yeah, but any fiber or food that you're putting in your gut, it's either going to. It's going to skew your gut microbiome towards something that is more beneficial or more detrimental.

And would you say that the prebiotic fiber and getting essential fatty acids, that would be important to do throughout the lifespan or just for people in their.

20S and 30s throughout the lifespan? Particularly important in the teenage 20s, 30s, because it helps with brain development. You're certainly more of an expert than me when it comes to brain development, but it does continue to develop through. Really throughout the lifespan, but certainly through the 20s and 30s as well.

What about taking a multivitamin while you're growing up? So many people do that. Is it necessary, Is it useful? And if it's not necessary, is it safe to do anyway?

It's generally safe to do anyway. I do not think everybody needs a multivitamin. The more exclusionary your diet is, for example, if you have celiac disease or if you're planning on fertility soon, then perhaps it's more reasonable to take a multivitamin.

In a previous discussion of ours, I asked you about caloric restriction and testosterone. And if I recall correctly, the idea was that if somebody is overweight, they have excess fat adipose tissue, then getting rid of some of that adipose tissue through caloric restriction and exercise, provided it's done not too fast in a healthy way, is going to be beneficial for testosterone in the long run. But that for individuals who are not carrying an excess of body fat, caloric restriction is actually going to lower testosterone. First of all, do I have that? Correct. And second, are there any addendums to that that you'd like to give us now?

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

Got it. Okay. So we touched on sleep being critical, I would say, throughout the lifespan, trying to get enough quality sleep. At least 80% of the nights of your life. And the other 20% are just what happens when there's noise outside or you're stressed. It just you have an exam or you're having a great time for whatever reason. There are a lot of good reasons to lose some sleep now and again as well. But so we have sleep, we've got nutrition, we touched on that. We'll get back into supplementation. What are some of the other pillars of creating the proper environment for hormone optimization?

Stress is probably the next one. During both puberty, but also the 20s and 30s, individuals are figuring out how they want to cope with stress and also figuring out what they want to choose to put their effort into. So if someone is overstressed, then it can have. It can put all the other lifestyle pillars, and then they stop dieting. Well, they stop exercising, and everything else can go askew. There is also some degree of social component to this. So perhaps I need to add a seventh pillar of social. You know, during your 20s and 30s, you may be forming a family as well. Perhaps you have children. And the health of the family unit is going to be vitally important, not only, not necessarily directly for hormone optimization, but it's going to throw everything else off if it's off.

And for people that are not starting their own families in their 20s and 30s, can that social connection be extended to friendships and work relationships as well?

Absolutely. In fact, if someone's not starting a family, it is just as concerning, but for other reasons. Each individual is going to have their close group of family and friends. And if someone does not have one of those connections, that's when things can potentially get bad, not just for them individually, but also society.

So when you say stress, you mean learn to manage your stress. What does that look like? I mean, if a patient, you know, has high blood pressure, even if they don't, you just sense that they're stressed, they have a lot of pressured speech, or they're not feeling well, or communicating that they're not doing well. What are some of the things that you recommend in order to try and ameliorate that stress?

There's different mindfulness or relaxation techniques. Going outside can often help with this as well. Dietary changes and exercise can help with this too. Some people like prayer or meditation, and a lot of people like counseling or therapy or even just talking openly with a family member or a friend.

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

Everyone should get outside and find a movement pastime to last a lifetime. You're going to get sunlight, you're going to get some degree of heat and cold exposure and you're also just going to move more. Being in an artificial environment where there's artificial lights, artificial air conditioning is going to have many effects on your body. So that's vital. Another one is finding what your purpose is in life. So I call this spirit. But it's really just the self actualization component of Maslow's hierarchy of needs, which is basically your physical needs, your mental needs, and then your purpose in life, what you really like to do, picking.

Some goal or target. And I always say that you don't have to stick to the same goal over time. Certainly I haven't. Although I got started early in the science game and I'm still in it. The idea is not to pick the end goal, it's to pick a goal and then once you reach that goal, to assess and then pick another goal and so on. I think sometimes when people hear about picking a purpose, they're like, oh, and goodness. I have to define sort of like naming oneself, that you actually can change your goals and purpose over time. This is terrific. Would you suggest that people actively use or avoid supplementation prior to doing all these other things? I'm somebody that likes to throw the kitchen sink at things, but I also like to do things pretty systematically. So I always say behaviors first, then nutrition, then supplementation and then maybe and if and only if there's a real need. And of course working with a doctor, prescription drugs. But you know, there are probably people in their 20s or 30s, maybe even in their 50s, that aren't feeling great and they want to do something in order to be able to train more or to feel more confident, to seek out social connection. They try and go, go about the whole business from the other, from the other side as well. What are your thoughts on that?

I see supplements and medications as very similar. One's prescribed and one's not. In general, medications have more side effects or potentially stronger therapeutic with more efficacy. But they're just tools to reach an end goal. So depending on the goal, if there's an individual that's an athlete, then certainly they should consider supplementation. Or if someone desires optimal or a very high level of cognitive performance, they should also consider supplementation. At the same time, food is medicine, and a lot of the benefits you can get in supplements, you can get in food as well.

I guess it depends on how much time and energy you're willing to spend. And also finances. I know that when I was in college, I could afford just a few supplements, and they were basically whey protein and some fish oil. I was fortunate that I was pointed in the direction of those things. And some creatine. I couldn't afford much else. Over time, of course, I could afford more. But it really does often depend on finances. Before we get into some specific recommendations to optimize testosterone, estrogen, thyroid growth hormone, et cetera, I want to ask you a question I've been wondering about for a long time. So often in the discussion about male hormone optimization, people will say, well, if your libido is suffering, you might want to be concerned about testosterone or even estrogen, right? Because we know that estrogen can impact libido as well. Sometimes having estrogen too low is detrimental for libido. Or that people will say, you're not recovering from workouts, or you're just. You're feeling kind of depressed. The problem is it's all subjective. So how does one know whether or not their recovery from workouts, their energy, their confidence, their libido is within a healthy range? I mean, obviously for people in a relationship, they can know whether or not their libido matches the sort of cadence of. Of the relationship and their partner. But how should people think about this and maybe even start to talk about it? Because one of the big differences, I think, between males and females is that because females have a monthly cycle, they are familiar with the changes that occur in their hormones over time. Because every 28 days, those hormones are changing dramatically in ways that impact their physiology and psychology. But for males, I feel like there's sort of a dearth of language to get into the more subtle aspects of this. It also has to do with privacy issues and people feeling like they don't want to overshare too much, not knowing what's appropriate to share. But when you talk to a patient who's in their 30s, or maybe even their 70s or 60s, doesn't matter, a male patient, what are you listening for? And, you know, I know you're not a psychiatrist, but you know, what are your ears tuned to in order to try and figure out whether or not this person could really use some help with hormone optimization or whether or not something else. Or maybe they're just doing great and they don't realize it because they're placing demands on themselves that are excessive.

You want to use a lot of open ended questions. This process is called motivational interviewing. And your goal is to listen to the patient and not plant an idea in their mind that they can follow because everybody is going to have a different goal. Some people are better at reading their biofeedback or telling how they feel on a daily basis. There is screening questionnaires designed, for example an ADAM questionnaire to look at men's health and hormone related health.

It's called an ADAM questionnaire.

ADAM questionnaire.

ADAM correct. Is it available online that people could administer it to themselves? Although we don't want people making clinical diagnoses of themselves or anyone else. Is it that sort of exam?

It is interesting. I don't believe it is a clinically validated tool like an ascvd, which is like a risk of heart attack and stroke tool or many other tools. There's one for depression, there's one for anxiety. They're called PhQ9 and Gad7 respectively. But anyway, there's often an in the Adam questionnaire and what you hear from the patient, if you are a very careful listener, is often different.

Can you give me an example of some of the questions on this ADAM questionnaire or the sorts of motivational interviewing that you might do? So say I'm your patient. We sit down. What sorts of questions would you ask to probe these kinds of dimensions of hormones?

Questions about libido, questions about athletic performance, questions about motivation. And often the patient will answer one thing. But what you hear from them subjectively is far different.

Interesting. Can you give me an example of a question? I'm happy to be the guinea pig here.

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

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

It can be related. In fact, erectile dysfunction is known as the canary in the coal mine. So coal miners would take the canary down and the canary would die before the coal miners would have, I believe, carbon monoxide poisoning. And often one of the causes of ED is plaque buildup, which can happen in the coronaries as well. But sometimes they notice the symptom in the genitals before they do in the coronaries.

So for such a patient, let's say that patient was a young person, where plaque buildup in the arteries and veins is not all that likely. If they're, let's say, in their 20s or 30s. What would be your next step of the interview at that point, and what would you consider? Would you immediately order labs for that person to try and rule out any kind of actual hormone level deficiency?

I certainly would order labs. There are some individuals that are very similar and they come in and they have the same symptoms. And one individual might have a very, very high testosterone, and one individual might be severely hypogonadal. So there's a big difference between this objective and what the labs look like. So I certainly order labs. You also ask them about if it's situational or not. You ask them if they have ed, if they're, you know, you ask them about their habits. You even ask about porn and masturbation and all these issues. And of course, it's between the doctor and the patient. And depending on what they tell you, you can often determine if there is a situational component. Some people call it psychogenic ed, but I don't love the term psychogenic ED because it kind of puts some blame on the patient's mind. But a lot of the time that is the case. There's even a test, and this is very rarely ordered, but it's called a nocturnal penile tumescence.

Is it true that there are periodic erections during sleep? Correct? Yes. Yes.

So you basically put a cuff to see if you're having a normal sized erection during sleep. And I believe about 90% of the time they do that test, they are indeed having erections, which would point to.

This psychogenic origin of whatever challenges they're having in terms of sexual interactions. You mentioned porn and masturbation. This topic has come up a bunch of times on this podcast and on other podcasts I've gone on because of the relationship between dopamine, sexual motivation and sexual behavior. And I've been of the pretty strong stance that while I'm not judging porn or masturbation, it can create a brain wiring situation where males in particular essentially teach their brain to be aroused by watching other people have sex, as opposed to being the first person actor in sexual interactions. So in that sense, that's more about the brain wiring and neuroplasticity and dopamine. But what are your thoughts on porn and masturbation as they relate to hormones? I mean, this is a big debate on the Internet. In fact, one of the most common debates is whether or not masturbation increases or decreases testosterone in males. Certainly it will decrease motivation to go find sexual partners. We know this, and there are more and more data on this all the time in terms of the effects of pornography and masturbation. And here, I suppose, we need to be somewhat specific and operationally define what we're talking about. We're talking about porn and masturbation to the point of ejaculation. Right? Because my understanding is that the ejaculation and orgasm associated with it cause an increase in prolactin, which blunts libido for some period of time. The duration of that will vary from person to person and circumstance to circumstance. But basically, all of this points to the fact that porn and masturbation can really limit libido in the real world. And to me, pornography and the screen is not the real world. Screens exist in the real world. The real world doesn't exist in the screen.

That's an accurate statement. And prolactin does have a significant acute increase after ejaculation. It does to some degree after orgasm as well. But prolactin acts on the pituitary to inhibit the release of the hormones LH and fsh, of which LH can increase testosterone. So this may be one of the cases where the dose makes the poison. And if it is a very frequent habit, certainly daily or more than once a day would be very detrimental from a hormonal component, not even taking into account the neural wiring.

Listen, I think it's terrific that you've actually defined frequency, because this is the problem on the Internet or even in the doctor's office, you'll see descriptions about pornography being dangerous for certain things or detrimental to hormones. People say frequent, but what's frequent? So you're saying daily or multiple times per day would be potentially detrimental to the hormone profile of a male of essentially any age.

And that's just for masturbation with pornography, with porn use as well, it would likely be worse.

Why is that? Just the sort of dopaminergic drive of the stimulus, just the really intense visual stimulus, dopamine sensitivity.

I think that using the analogy of a dopamine wave pool, it would deepen the pool but not increase your supply of dopamine.

Maybe you could describe the dopamine wave pool, because I think it's such a powerful way of thinking about dopamine and what dopamine does. In fact, I've always credited you when I've done it. But I've generally stolen your analogy of the dopamine wave pool because it's so astute.

The dopamine wave pool describes the natural variation of ups and downs in your dopamine or your motivation. And in the wave pool, depending on how high the peak is, you often have a deeper trough, so you do not want too high of a peak. In addition, if your peak is very, very high, for example, when you're using many substances like cocaine or like amphetamines, your dopamine can go so high you lose almost all the water from the wave pool. And then when you crash from that, not only is the trough low, you have less dopamine in the pool to begin with. The dopamine receptor is extremely sensitive, as is the GABA receptor, which is an inhibitory receptor. Whereas dopamine is technically a stimulant related to adrenaline or noradrenaline, the depth of the pool can change very quick. So you want to have that happy medium where you're fairly near the top, but you're not so near the top that the depth of the pool is going to go down.

So if I interpret that in the context of this discussion about libido, sex, porn and masturbation, if somebody has a very intense sexual experience, and here we're not necessarily talking about an intense orgasm, we're talking about just an, you know, a lot of intense visual. So very. A lot of intense imagery or auditory input or both, that is going to lead to a situation where dopamine is going to be depleted afterwards.

Correct?

A guest on this podcast before, my colleague at Stanford, Dr. Anna Lemke, who's expert in addiction, talked a Bit about this, the sort of see sawing here. We're talking about a wave and a crashing out of the water from the wave pool there it was a seesawing from pleasure and pain. There's going to be a longer and deeper period of lack of pleasure following that. And I think a lot of people think, oh, well, that's great, they want the intense experience. But if that intense experience is coming from pornography and masturbation, or I suppose coming from high adrenaline activities like life risking parkour, hanging off the side of a building, it inevitably is going to lead to depressive episodes, low libido episodes that follow. Is that right?

Correct. In a similar physiologic way to withdrawal from stimulants like amphetamines.

Now, is sex with a partner different? Because there are many people who are chasing more and more intense experiences with a partner as opposed to through pornography and masturbation. Again, here we're talking about all ages, and I should always say anytime we're talking about sex with a partner. We're talking. The four conditions that I was lay out on the Huberman Lab podcast are that we're talking about consensual, age, appropriate context, appropriate species, appropriate interactions.

Yeah. And this is also a case where the dose makes the poison. So if there's, you know, obviously meeting all those criteria, if they have one preference that for both of them is a positive experience, then that is likely. Okay. You're not going to be able to maintain dopamine over a certain threshold for a long period of time. So there very well may be a crash from that experience as well. And the crash may be different in one partner than the other.

Interesting. I'll draw an analogy to food. It'll be like, you don't have to serve the banquet meal seven nights of the week, maybe just two. Is that right? And there are other delicious foods out there. Can we use that analogy?

That is very reasonable.

Okay. Not trying to be PG13, just trying to parsimony Occam's razor, the ability to describe a lot of things in a few words. I'd like to return to the key things that people should do, or I should say the key things that men should do to optimize their hormones. So we talked about getting some movement, getting some sunlight, getting quality social connection one way or the other. Avoid excessively frequent masturbation and viewing pornography. And for some people, zero might be the optimal number. And I keep coming back to this for most people. Interesting. I feel so fortunate to have grown up prior to the availability of Internet pornography. I've never been a big consumer of pornography. It's just not been my thing. But I hear so often from males of all ages about their addiction to it, their affliction by it. It's really a serious issue. And that's one of the reasons why I'm grateful that you're willing to talk about this and your clinical experience with these patients. I'd like to take a quick break and acknowledge one of our sponsors, athletic greens. Athletic greens, now called AG1, is a vitamin, mineral probiotic drink that covers all of your foundational nutritional needs. I've been taking athletic greens since 2012, so I'm delighted that they're sponsoring the podcast. The reason I started taking athletic greens and the reason I still take athletic greens once or usually twice a day, is that it gets me the probiotics that I need for gut health. Our gut is very important. It's populated by gut microbiota that communicate with the brain, the immune system, and basically all the biological systems of our body to strongly impact our immediate and long term health. And those probiotics and athletic greens are optimal and vital for microbiotic health. In addition, athletic greens contains a number of adaptogens, vitamins and minerals that make sure that all of my foundational nutritional needs are met. And it tastes great. If you'd like to try athletic greens, you can go to athleticgreens.com huberman and they'll give you five free travel packs that make it really easy to mix up athletic greens while you're on the road, in the car, on the plane, et cetera. And they'll give you a year's supply of vitamin D3K2. Again, that's athleticgreens.com Huberman to get the five free travel packs and the year's supply of vitamin D3K2. In terms of exercise, you know, here's again, it's a double edged sword. Um, on the one hand, it's great to get exercise, but I'm familiar with, you know, if I train an hour a day, you know, 10 minutes of warmup and 50 minutes to an hour of weight training, or 50 minutes to an hour of cardio, I feel great. Especially if once a week I take a complete day off. That's sort of my general schedule. I'm also familiar with when I go out for runs that are excessively long, two hour runs, or I spend 90 minutes in the gym too frequently, start to feel like garbage, everything suffers, my sleep starts to suffer. It doesn't matter how much I eat, I don't seem to recover. I don't feel well. So I realized that recovery ability varies between individuals. But what do you think is a healthy sustainable exercise regimen that anyone can follow that will also support their hormone status?

For really vigorous exercise, around three to four times a week is very sustainable over a long period of time. On top of that, you could add in three or four more instances of less vigorous exercise.

Okay, so for less vigorous would you mean zone 2 cardio where you can hold a conversation, but beyond which you can't. And for more vigorous, you're thinking weight training or high intensity interval type training, is that right?

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

So here again, like to perhaps drill into this notion of intensity and light weights because for me some of the most brutal workouts I've ever done were in what I would consider a high repetition range, 15 to 50. Actually I went up to Oregon to watch the International Track and Field Championships. We went by to Cameron Haynes's place, right, the Cameron Haynes and he and his trainer put us through a workout that was 25 to 50 repetitions per set. And it was done in circuit and it was brutal. So it was light. I mean that's. Those weights were nothing. In some cases it was body weight. But the number of repetitions was brutal. So when you say limiting intensity, are you talking about limiting the number of sets to failure? Are you talking about really being kind of a lazy bear in the gym? I like to do that every once in a long rest, that sort of thing. What are your thoughts on that as it relates to hormone optimization? So I'll just mention and then I'll let you answer. I feel best overall when I'm training for 10 minute warmups and about 45 or 50 minutes of weight training where I'm pretty lazy between sets, 2 to 3 minute rest training, somewhere in the 6 to 10 rep range, going to failure every once in a while, but mostly getting that sort of last rep before what I would think Is failure, no forced reps, that kind of thing. And then jogging on the other days, nice and easy. When I do that, I feel fantastic in all other dimensions of life. When I train more intensely than that, even with lightweight, so faster cadence and lower rest, I feel like garbage. I get a headache, I'm kind of ornery. Everything suffers. So what are your thoughts on kind of defining a optimal exercise strategy for hormones? I've never measured my hormones in those two different contexts, but I have to imagine that it's cortisol related.

When they study the effect of exercise, specifically vigorous exercise, one area that's been studied is vigorous exercise episodes lasting longer than an hour. And they usually track it by a rating of perceived exertion, which isn't perfect and it's not extremely actionable, but it's helpful for clinical science. But the takeaway from that is basically do not, it is not hormonally helpful to train especially regularly, train vigorously for longer than an hour.

Great. So I'm happy to hear that because it sounds like for most people that hour of work is really the threshold. I think this is important for people to hear, especially males, because I think with all of the incredible examples out there of people like Cam, like David Goggins, people who are training for very long periods of time, you know, and leaving aside all issues of what people are doing in order to optimize the recovery, I think an hour a day of exercise is just a great program that most anyone can follow. And beyond an hour, you start running into challenges and I, you know, the occasional 90 minute or two hour workout is no big deal, but if you start doing that more than once every two months, I think you're headed for trouble. Have you seen that in people's blood, blood work and in their hormones? Do you ever see people that are just badly overtrained because they're just training too hard and too often?

Yes. When the blood work is particularly bad, they're often in a large caloric deficit as well. There's a synergistic effect between a caloric deficit. Even if you're maintaining adequate protein intake, you might not be maintaining adequate iron intake or adequate vitamin D D. And you're also just literally in a caloric deficit, perhaps low carbs as well, very low free testosterone, and they're simultaneously doing a lot of vigorous exercise.

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

Consistency is key here. If you are not consistent, then the law of diminishing return certainly applies. So 80 or 90% of the benefit over many, many months is far better than 100%, but only half the time.

Yeah. One thing that I found to be tremendously useful is to finish the workout while I still have energy, to not take myself to exhaustion. And then I'm able to kind of talk about the dopamine wave pool. I'm able to sort of ride that into the rest of the day feeling great. I sort of save or bank some of the vigor from the training to bring it into my work. But then again, I'm not an athlete. I get paid to think and to speak, not to, not to lift weights or to run.

Another component of that is the balance between your sympathetic, which is your fight or flight nervous system, and your parasympathetic, which is your rest or digest nervous system. There is an anecdote, which is likely true, that many elite bodybuilders are very parasympathetic besides while they're lifting weights.

You mean they're lazy and they like to eat a lot? Yeah, the lazy bear in the gym kind of phenomenon.

Absolutely. But that being said, after a very, very vigorous workout, for example, one where you're trained to failure, which bodybuilders and powerlifters do all the time, you feel the tiredness or you feel the strain from that heavy sympathetic activity when you are lifting a heavy weight and it can potentially affect how you feel the rest of the day. So many people who have a job where that is highly cognitive do not like to have an extremely vigorous workout in the morning, which is when a lot of people are able to exercise.

When I exercise early in the morning, that is before 9am, I have more energy all day long. If I do it mid morning, I have experience more of an afternoon crash. There's probably some circadian biology in there. I also noticed, and I've actually seen in my blood work, that if I don't get out for a 45 minute jog at least once a week, all of my blood profiles suffer in the direction that I don't want them to go. In particular, testosterone and estrogen move in directions that are not conducive to my goals. I'd like to talk about some of the approaches that people can use in order to optimize hormones. And these days, for better or for worse, I think for worse, younger guys are asking about and using testosterone replacement therapy, so called trt. And I just want to frame this up by saying there is no strict cutoff for what is trt. There are plenty of people whose blood levels of testosterone and estrogen are within the normal reference range and decide to start doing these things. Of course they can limit fertility. There are a bunch of issues even at non steroidal performance enhancing dosages. I'd love to frame this up by first defining our terms because one of the challenges on the Internet is people talk about trt, then they'll talk about performance enhancing drugs, they'll talk about steroids. They're all steroids, right? I mean, testosterone, estrogen are both steroid hormones. But what one considered replacement therapy versus what one considers performance enhancing is going to depend, right? So here's my question. Why in the world, why in the world would any male in his teens or 20s or even 30s, whose blood levels of testosterone and estrogen are at the appropriate levels, meaning within the normal reference range, why would they take exogenous testosterone given all the negative effects on fertility, some of the challenges that it can present if the dosages aren't quite right, et cetera, why would they do that? Certainly if they are not being paid for a particular endeavor, like they're not making money, if they are playing a sport, chances are they're not allowed to do that anyway. It's on the banned substances list. So to me it just seems like a crazy idea. But then again, I'm of a generation that really hasn't thought about doing that stuff until people were in their 40s and 50s, or even never. So is there ever a case for somebody in their 20s or 30s to take testosterone if their blood levels are within the 300 to 900 nanograms per deciliter reference range?

Not many cases. The reason for any performance enhancing drug, whether or not it is a steroid, synthetic, bioidentical or otherwise, it varies a lot. Some individuals do it only for cosmetic reasons. Even if it can have deleterious effects on like the cosmetic appearance, for example, of your skin in the long run. But you know, everyone has their different reason as far as like, when does the benefit outweigh the detriment? Not very often. If you're in your 20s and certainly probably almost hardly never. There's always, you know, rare cases like Kalman syndrome and whatnot, but almost never if you're very young.

Okay, so for people in their 20s, 30s and beyond 40s, et cetera, whose testosterone and estrogen levels are at the appropriate ratios and within the normal reference range, and they feel pretty good, right? We talked about the Adams exam or this sort of like, feel pretty good as sort of code for libido, energy recovery, et cetera, and are feeling at least workable for their lifestyle. For those people, what can they do besides get great sleep, train, but not too hard or too often, et cetera, et cetera. What are some of the things in the realm of supplementation that can help them optimize their testosterone and estrogen without suppressing their own endogenous production of testosterone and estrogen?

Let's mention creatine as the first one. Creatine is interesting because it has multiple different effects. It helps with amino acid synthesis. It also helps with oxidative stress. It can also serve as the backup fuel tank for your mitochondria. So kind of holding back up ATP. And it does slightly increase total testosterone. And it also increases the conversion of testosterone to dihydrotestosterone. So potentially it's especially useful in men in their. Even their teenage years and their twenties.

You mentioned the conversion of testosterone to dihydrotestosterone. And there is mythology out there that creatine can increase hair loss. I'm guessing because there's at least one study showing that creatine can increase dht, dihydrotestosterone. And DHT is one of the primary hormones that can promote male pattern baldness. So the question therefore is, does creatine supplementation increase the rate of hair loss?

Theoretically, it can, but in each individual, preventing hair loss is a very poor reason to take creatine because it's not going to take you to a suprafic physiologic level. It's not going to, you know, increase your androgens to an unnormal level of binding. So I feel like this, if that was a reason to not take creatine for hair loss, then I mean, for.

Sorry, you mean hair loss is not a reason to avoid taking creatine?

Correct. Hair loss is not a reason to avoid taking creatine. It think of it as just bringing you to what you are naturally inclined to have. If your conversion of testosterone to DHT is already high, then often creatine does not affect this. It just kind of Resets your balance between testosterone, being aromatized to estrogen or being 5 alpha reduced DHT. So it's not going to speed up hair loss more than just naturally being a male does. So in some individuals it will have no effect. In some individuals, for whatever reason, they have almost no 5 alpha reductase activity. It will return them to natural or normal.

I see. Well, I take five grams a day of creatine monohydrate. I do it for the tissue voluminizing effects, for exercise benefits, but also for the cognitive effects. I don't know if it's increasing my hair loss. I mean I've got a little bit of sort of widow's peak type hair loss. That's where it is for me, I suppose. Beard growth is associated with DHT too Most. Is that right? What I learned. But then again I haven't been into this literature in a long time. Is that because of change differences in receptors that DHT causes hair growth on the face and hair loss on the head, is that right?

Yes. And the amount and the sensitivity and density of those receptors is genetically determined.

And is it true that if your mother's father was bald that you will be bald in the same pattern and if that he wasn't, you won't?

That is a decent correlation. Part of the proposed mechanism of this? Well, there are several genes and you can actually test your genes for hair loss. You do get a decent amount of them from your mother. The unique thing you get from your mother that she may have gotten from her father, that she got one of the copies from her father is your X chromosome and the androgen receptor gene is on your X chromosome. So all men got their androgen receptor gene from their mother.

It's on their X chromosome, not on the Y chromosome.

Correct.

Interesting. Even though all of the sort of quote unquote male promoting genes are on the Y chromosome, like mullerian inhibiting, et cetera. Interesting. Okay, so five grams a day of creatine for most people should be fine. Beneficial for tissue voluminizing. So strength bringing water into the muscles and for the cognitive effects. And the clinical support for creatine I think is quite Strong at the 5 gram per day dosage. What other sorts of supplements can people benefit from? We already talked about the omegas and making sure that people are getting enough prebiotic fiber to support the gut microbiome and vitamin D. So what other supplement based tools can people consider?

Another one we can loop in with creatine is betaine. Some people are non responders to creatine so you can increase that to 10 grams, or you can use its cousin betaine to help with amino acid synthesis and shunting of energy. Along with that, I would put L Carnitine, which is actually the smallest peptide hormone. It's just two amino acids that are put together. So it's a.

It's a hormone. Interesting. I'm not challenging peptides. Yeah, I'm not challenging.

I would call it a peptide more than a hormone. So I would not call L carnitine a hormone.

Okay.

But I would call dopamine a hormone.

Yeah, I could. A neurohormone. It's so hard to define things as transmitters or hormones at some level. I agree. So L. Carnitine. Actually, I should backtrack betaine. Do you recall what dosage people typically would take if they're a creatine non responder?

One to three grams, in fact. Yeah. Several versions of creatine have betaine mixed in because it helps with the processing of methionine and homocysteine.

So if somebody is already taking creatine and likes it in response to it, I'll raise my hand. Such as myself. Would adding betaine help or is it redundant with creatine?

Only if their homocysteine is persistently elevated. And homocysteine is kind of like an inflammatory marker that can build up if you're not converting enough of it downstream.

How would I know?

Just a blood test. Or if you knew your MTHFR polymorphism, which is basically how you add methyl groups to many things in the body. Great.

Any side effects of betaine that people should be aware of?

Not that I know of. Okay.

People can look it up on examine.com is a great site for that. They'll surely list it. They just revamped their site, by the way, and it was awesome before and it's platinum now. So L Carnitine, what are the ways to take L carnitine? I know that there's an oral form, so capsules, and there's injectables. The injectables, I think you need a prescription, is that right?

Correct. You need a prescription for the injectables or you should really get a prescription for the injectables. For when you inject it, of course, at the supervision of your doctor, it's usually done intramuscularly. It's an aqueous solution. So it does not have like an oil or a carrier oil in it like testosterone esters do. However, if you inject it too superficially, it's not Going to make it rake anything. Often it just burns if you inject it subcutaneously and it does not disseminate throughout the body as well. L Carnitine potentially has localized effects if you inject it. If you ingest it orally, then it has a very low bioavailability, maybe only 10%.

Well, I think most people are going to be able to get L Carnitine only or in its capsule form. So what are the dosages of L Carnitine that one needs to ingest then, if they want to get a benefit? Because if only 10% is being absorbed, it's probably a lot of L carnitine. How much should people take per day?

Usually I recommend for oral L carnitine between 1,000 milligrams and up to 4 or 5,000 milligrams.

So 1 to 4, maybe even 5 grams.

Correct. Up to 5 grams a day. If you're on that much, especially if you have a dysregulated gut microbiome, you should be concerned with tmao, which is a potential carcinogen that both carnitine and choline can convert into. And your gut microbiota determine how much that happens.

Is it true that I can offset any negative effects of alpha GPC choline, I.e. n L carnitine that I take by ingesting garlic? Is that right?

There's a compound in garlic called allicin. I believe it's a L, L, I C, I N. It's also part of the scientific name, the genus of types of garlic, and this can help decrease the conversion to tmao. Berberine actually slightly decreases the conversion to TMAO as well, probably through alteration of the gut microbiome. And then just optimizing your gut microbiome can decrease conversion. So not everyone needs allicin, but it's something that you should certainly consider if you are on a high dose.

I'm going to continue to take the 600 milligrams of garlic every time I take my L Carnitine, but I'm going to skip the berberine because berberine gives me brutal headaches and it makes me crave carbohydrates because it drops my blood sugar.

It has many other effects, including the dawn phenomenon where it drops your blood sugar when you're sleeping and you can't even realize it.

I am not a fan of berberine, and I'm sorry for those of you that are. I'm not trying to offend anyone. Although, frankly, if you're being offended by my stance on Berberine, then maybe we should have another discussion. In any case, injectable L. Carnitine, if one can get that through a doctor, how much is absorbed and how much should one take?

Almost all of it's absorbed. In general, you're taking between 500 milligrams up to. You can take a pretty high dose up to 2,000 milligrams.

Okay, and what we did not talk about is what L. Carnitine does. So why should, why should someone go through all of this? Is it to optimize testosterone? Is it working on the receptor side? What. What's L Carnitine doing?

It's a shuttle, so I think it's named carnitine palmitel, coenzyme A. Basically, it's. It just takes nutrients from outside your mitochondria and puts them in. It also has a unique effect. Well, not too unique, because tadalafil actually has this effect as well, is that it increases the density of the androgen receptor in the cytoplasm of your cells. So even if your androgen receptor sensitivity doesn't change, and even if your testosterone does not change, you will have more testosterone binding to that increased number of receptors.

Does one need to cycle L carnitine, creatine, betaine?

No reason to cycle any of those.

Okay, what other supplements can one use to try and improve hormone profiles? And here I realize we're using a very broad brush because when we say improve hormone profiles, what are we really talking about? And for me, at least, I think about the subjective stuff. Do people feel like they are going to have more energy as a consequence of doing these things? Are they going to have the more optimized libido? Are they going to have more optimized recovery from exercise? Right. Because, I mean, it's not clear to me that taking one's testosterone from 600 to 800 is always going to be a good thing, especially if estrogen is increasing in parallel. That could cause issues. It could certainly make things better. It could certainly make things worse. Right, so with that backdrop, what are some of the other things people can take? And then we'll go back to this issue of what really is optimization.

Let's briefly mention vitamin D, which is also a hormone. It's actually a sterile hormone. And if you have deficient vitamin D and you replace it, then you will optimize your testosterone. Let's also mention boron. So if you have a very high shbg, boron can acutely help lower it, usually in a dose of 5-12mg per day. It's not really a sustained effect. But boron is depleted in soils in many countries. I believe it's very high in soils in Greece and Turkey. So eating dates or raisins that are from those areas potentially have more boron. Boron also might be one of the reasons why the reference range for testosterone is much higher in those countries than other countries.

And just to remind people, the SHBG sex hormone binding globulin is attaching to the testosterone molecule and limiting the amount of so called free testosterone that's available to have its impact on cells. When Dr. Peter Attia was on this podcast, in fact sitting in that very chair, he said that the ideal level of free testosterone in males should be about 2% of one's total testosterone. Would you agree with that number or disagree? I'm sure Peter would be fine if you said either.

2% is a good rule of thumb. Usually the reference range is between about 1 and 4%. Some people do have genetic polymorphisms in SHBG, a specific gene mutation where they have very low SHBGs. Also, men that have varicose veins in their testes, also known as varicoceles, tend to have very high SHBGs. So that percentage would likely be less than 2%. So just because your percentage of free tea to total tea is a little bit above or below 2%, that's okay. We just need to figure out the reason why it is.

How would somebody know if they have varicose veins in their testicles, especially if their testicles are still in attached to their body?

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

The other way is to do a scary visual.

Yeah, bag of worms.

Yeah. Well, just that. Yeah. Anyway, I think parasites when I hear that. But that's not what you're referring to. You're talking about just the, the, the texture.

The best way for most people to check is to valsalva for a long period of time. When you val salva venous return will decrease.

Can you explain Valsalva for people?

It's bearing down like you're lifting a weight or having a bowel movement where you swallow. And a lot of times you can almost see buildup of blood in your like jugular veins as well. So you have decreased blood return to the heart and increased blood in the veins themselves.

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Right.

And then what are some of the other things to optimize testosterone that are in supplement form?

We can talk about things that affect the steroidogenesis cascade. So we could touch on Tongkat. Ali, I know we've talked about that a little bit before.

Yeah. But I'm guessing a number of people probably haven't heard that conversation.

Also known as longjack and that upregulates several different enzymes in the steroidogenesis cascade. And by that what you mean if and this is another good thing to Google. I think anybody interested in hormone optimization should understand where sterol hormones come from. They come usually from cholesterol and they can be shunted off to vitamin D very easily. They can be shunted off to testosterone or estrogens or progestogens quite easily as well. But tongkat helps with the conversion of multiple key steps where you synthesize testosterone. Another think of it as like a coenzyme or a CO factor, an upregulator of these steps is insulin and IGF1. So a good rule of thumb is if you are not expecting as much growth hormone, insulin and IGF1, for example, lower carb diets, caloric deficits, you're trying to cut body fat or body weight, then tongcat is going to be theoretically especially powerful.

What sorts of dosages of Tonga do you recommend to your patients?

Anywhere from 300 to 1200 milligrams a day. With tongkat, you need to be careful with the standardization because. And if you're thinking about a general tongkat supplement, which is by far the most well studied, then you're looking at the uricomanone content, which is a plant compound that is likely the main active pharmacologic effect. So that's the compound that's having the effect on the body. And if you standardize the Yuri Kominone very, very high, then theoretically you're having more effect at a lower dose.

I take 400 milligrams of Tonga Ali per day. I take it early in the day because it has a bit of a stimulant effect. And if I take it after 2pm it starts to inhibit my sleep. I've been taking it for years, and I rather like the effects that it seems subtle but, you know, consistent. I've never cycled it. Do you recommend cycling it?

I don't see any reason to cycle it. There is. There is a reason to cycle some supplements, but no reason to cycle Tongkat.

My blood work tells me that it causes an increase in free testosterone for me and also a slight increase in luteinizing hormone for me. What are some of the other effects on various hormones that you've observed in the blood work of your patients taking Tonga Ali?

Tongkat can also slightly increase dhea. And if you have a very high shbg, again, that's the protein that binds up your androgens and estrogens, an extremely important protein. The higher your SHBG, the more it helps decrease it. So they've studied Tongcat in populations with very normal SHBGs, and it does nothing for SHBG.

Interesting. Does that mean it does nothing for somebody overall? So if somebody has SHBG that's in the normal range, will taking tongat benefit them in any other way?

Yes, it'll increase their total and free testosterone.

Got it. Okay. Is it known to have effects on anything else, like thyroid hormone, growth hormone, or is it purely in these steroid synthesis pathways, or steroid, I should say, synthesis and receptor and modulation pathways?

There's no direct effect on those pathways. However, anytime you alter your free androgen or free estrogen, particularly one without altering the other, it will alter the binding protein that binds thyroid hormones. So any change you make, whether it's natural optimization or hormone replacement, you're going to slightly skew your thyroid hormone profile. One common, like actionable example of this that I see often clinically, is someone starts, let's say estrogen replacement or testosterone replacement. Maybe they're taking an AI with their testosterone replacement.

Aromatase inhibitor.

Correct. An aromatase inhibitor which blocks the conversion to estrogen. If they're taking testosterone and they have very little estrogen, then you're going to decrease the binding protein, also known as thyroxine binding globulin, which binds active thyroid hormones. So if you start TRT and you either have low aromatase activity or no aromatase activity, no conversion to estrogen, then your free thyroid hormones will go up, even just acutely, usually feedback inhibition, which is how the body talks to itself and says, you know, we need to make more of this or less of this. But acutely, there's not always enough time. You're going to have very high thyroid hormones and you can have tachycardia, which is a fast heart rate, or you can feel kind of like overly fight or flight due to increased thyroid hormone activity in the in tissue.

Interesting. Okay, so tongali, this, that's a broad range, 300 to 1200 milligrams per day. And I realize that the source matters there. What are some of the other hormones that you prescribe to your patients who do not want to go on testosterone replacement therapy or take exogenous DHEA or anything like that?

We could talk about fadosia next. Fidosia is interesting because it's a genus of plants. Fadosia agrestis is one of them. There's many others that are very interesting. That species is likely the most well studied. And it will increase lh. I would not consider it an LH mimetic. So it doesn't really mimic it, but it increases the release of luteinizing hormone from the pituitary. That's a hormone that it binds to the Leydig cell, to the LH receptor, kind of like HCG does, and it will increase the release of testosterone.

I see. So I think for people that aren't familiar with hcg, so human chorionic gonadotropin is basically synthetic luteinizing hormone. And luteinizing hormone is the hormone released from the pituitary that is going to travel down to the testes to stimulate the production of sperm and testosterone, but mainly testosterone. Is that correct?

Mostly correct. Technically, synthetic LH is also known as little R LH or recombinant LH and HCG can be synthetic, but often it is just refined from the urine of pregnant ladies since the placenta makes it. That's why it's called chorionic gonadotropin.

So where are they getting all this pregnant women's urine? I mean, there's their A location. I mean, not that I want to go there, really.

So there are women in trimester pregnant ladies, it's very high, donating their urine.

And then they're purifying it and then men are injecting it.

Yes.

Wow.

And that's actually the same for menopausal ladies. So first trimester pregnant ladies, that's how you can make, you know, non synthetic hcg. And then for minotropins, which are also known, there's a couple of different names for it, like menopur. You have menopausal ladies that have very high LH and fsh, and then you refine the FSH and lh.

Okay, so moving away from the sources and from urine, Fadogia agrestis, what dosages do you have patients take? I've heard of some potential toxicity to the testicular cells.

There is one study, and this is a rat study. But you can equate the dose of toxicity in rats and humans. They did not give these rats any antioxidants, but it increases a couple different, like pro inflammatory markers. One is ggt, or gamma glutamyltransferase, comes from both the testes and the liver. And one is alkaline phosphatase, also known as ALK phos. Again, coming from both areas, there are several different ways that you can attenuate this increase. And you can also just check to see if you have increased in the rat dose that equates with humans that had no effect. So the safe dose was an average of 300 milligrams a day.

So that would be 300 milligrams a day in humans. Is the dosage that did not have toxicity correct?

Correct. And often, even if there is toxicity in rats, there is not toxicity in humans. So it's not directly equitable. But to be safe, another regimen that I have people take is 600 milligrams every other day or 600 milligrams three times a week, often Monday, Wednesday, Friday.

This is very interesting and relevant because I've been taking Fadogia for Some period of time. All my markers and tests indicate that there's no toxicity. But I've been taking 600mg per day. But I've been cycling it for about eight to 12 weeks on and then a few weeks off. But based on what you're saying, I'm thinking maybe three times per week or every other day might be better. Is that right?

If you aren't going to get any labs, that is certainly the regimen that you want. If you're going to check your GGT and alk phos or even take other things to prevent those from increasing, then you can certainly be more aggressive with your fidosia dosing. You can increase it quite a bit and it has a dose dependent response in both the activities associated with high testosterone and also just LH and testosterone. So a more aggressive regimen would be 600 milligrams daily for a month and then take one to two weeks off.

Great. I think that's more or less what I've been doing. Okay, terrific. In terms of other hormones, what are some of the supplements that can support growth hormone? Right. A hormone that's associated with tissue repair and in some cases metabolism and fat loss. What are some of the tools, nutritional and or supplement based one can do to tap on the growth hormone pathway? And let's lump IGF1 in there too, since they're essentially working along the same dimensions.

A quick synopsis. Growth hormone is a peptide hormone and it is released by the pituitary. There's growth hormone releasing hormone and ghrelin that stimulate the release. So there's also peptides that are very analogous to these two things. You have that pulsatile secretion of growth hormone in a very fast half life of just minutes and then it increases IGF1. There is both peripheral IGF1 and central IGF1 and IGF2. But no need to get into the specifics. There is a happy medium to where your growth hormone is at a adequate level and your IGF one is an adequate level. Usually those two are congruent. So in most cases we just check an IGF1 and occasionally the binding peptides for IGF1. Kind of like SHBG that we talked about earlier here. But you're estimating a free IGF one. It's kind of confusing because all hormone, almost all hormones have binding proteins to help regulate them. But often you want to look at free testosterone, free estradiol, free IGF 1 or at least estimate it, free cortisol even and free thyroid hormone. But when you're talking about growth hormone and IGF1, usually you don't need to do anything to optimize it. If you are diabetic, then depending on the type of diabetes, your IGF1 and growth hormone can be too high. Specifically in type 1 diabetes your growth hormone is extremely high, but your IGF1 is low. So if you're in a dysregulated state or have pathology, I would just talk to your doctor about IGF1 or growth hormone taking thing. Taking amino acids before you go to bed could potentially help with growth hormone release just because most growth hormone is released while you sleep.

I've heard that fasting can increase growth hormone and I know there are certain patterns of weight training that can increase growth hormone. Some of those regimens in the weight room that increase growth hormone have been covered by Dr. Duncan French who is a guest on this podcast. So maybe we'll refer people to that episode for the specific protocols. These high volume training.

During those training exercises it usually does it transiently for a period of a few hours and it a lot of this IGF1 is released by the muscle itself, so it's not necessarily released by the liver. IGF one that is released directly due to growth hormone signaling, usually the growth hormone comes from the pituitary and binds to the liver where it usually has a half life of about a week where the paracrine or autocrine think of it as like the peripherally acting or acting in the muscles itself, which is also helpful, is released and is not as concerning because it's not related to insulin resistance, but it is related to the training itself.

So fasting and growth hormone Is it true that fasting can increase growth hormone? And maybe as a little related tangent, I've heard that limiting food intake for the two hours before going to sleep can increase the pulse of growth hormone that one experiences during sleep. Of course everyone gets a pulse of growth hormone during sleep, but especially carbohydrate laden meals can blunt that peak that occurs during sleep quite substantially. So two questions. Does avoiding food intake in the two hours prior to sleep help increase growth hormone release? Maybe it's being overly neurotic. Maybe people need to avoid food in the four hours before sleep. But regardless, what is the relationship between fasting and growth hormone release? I find this really interesting.

Fasting certainly potently increases growth hormone release. However the end binding to the receptor is less sensitive. So although fasting does increase growth hormone, the genes that are downstream to it, both the growth hormone genes and IGF1 related gene transcription activity will not be significantly higher. However, if you are optimizing the growth hormone that is released as pulsatile secretion, it is helpful to avoid eating for two hours. So the general rule of thumb is avoid eating about two hours before bed. I think that's clinically significant and helpful. But fasting otherwise, specifically for growth hormone optimization in someone who already has normal growth hormone signaling is not helpful.

That's extremely useful to hear because one of the major reasons why people fast is to get that growth hormone increase. But if they're adjusting things on the back end that negate that, well, then no such luck. Not that I have anything against fasting. I do a pseudo intermittent fasting mostly because I prefer to eat at fairly regular times of day. Okay, so it doesn't sound like there's a lot that people can take in supplement form to improve growth hormone. What about thyroid hormone? What are some of the things that people can take or do in order to make sure that their thyroid hormone levels are appropriate?

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

So ingesting iodine containing salt is useful? Yes or no?

Iodized salt does prevent goiter, but it is not necessarily the ideal form of iodine. Good forms of iodine often come from the ocean. If you look at a chart of hypothyroidism, there is a tendency to have more hypothyroidism the more inland you go.

So trying to eat some cruciferous vegetables each day would be the best way to improve thyroid hormone.

Along with plenty of iodine. You don't want too much iodine signaling. Many people are familiar with radioactive iodine tablets and that's basically an extremely high amount of iodine to block out the radioactive iodine that comes from after a nuclear meltdown or whatnot.

So we've got creatine, betaine, L, carnitine with allicin, garlic to offset the TMAO, vitamin D3, Boron, Tonga, Ali, fadogia, some fasting. Love to talk to you about peptides. So I can imagine a hierarchy. The hierarchy starts with behaviors and nutrition. Behaviors of course, includes training and limiting stress and all the things we talked about before, sunshine, et cetera, and optimize nutrition. Then we talked about supplements, all the things we just listed off to optimize testosterone. And we can get into this, but estrogen as well, which is important for libido and brain function and tissue function and joints feeling good, et cetera. But then we get into the realm where one might or could consider exogenous hormones taking a small dose of testosterone or taking a small dose of of gh, even if you know if that were appropriate and certainly only working with a doctor. But in between there's a step of so called peptides. And of course there are many peptides. We've already talked about some of them. But when people talk about taking peptides, the ones that I hear most often about is a category that increases GH and IGF1. And those to my knowledge go by the things like Sermorelin, ipromorelin, Tessamorelin, sort of a kit of things that taken separately or in combination to increase GH and IGF1. But then other people, for instance, are taking peptides like BPC157 to try and improve tissue healing and recovery. There's a lot of interest in peptides. Please, if you would tell us about what you know about the safety of peptides in terms of their sourcing and the utility of peptides. You know, is this something that people should consider before thinking about hormone replacement? Should people be wary of these things? I am very wary of particular sources that are sold online that are not clean, they contain contaminants and it could be dangerous. I really would love your thoughts on peptides. So I'm just going to sit back and let you riff on peptides. But if you could touch on some of the ones that I mentioned, I'd be most grateful.

A peptide is just a chain of amino acids between two and a couple hundred in length. So I think of peptides as several different categories. And the GHRPs that you mentioned, I would consider those. And that stands for growth hormone releasing peptide. You have two main types the ghrelin agonist. That or they hit the ghrelin receptor and though it helps release growth hormone because of that. And then also the GHRH like peptides, so they're very similar to growth hormone releasing hormone. Often they just change a couple amino acids and it acts like that. Tessamorelin is one of them, Sirmorelin is another one, and CJC is another common one. I believe those are all in the class of GHRH like peptides. Whereas ipomarelin or ibutamorin, which is Also known as MK677, those two are in the class of ghrelin agonists. So they're more like they hit the receptor that ghrelin does, whereas the other ones hit the GHRH receptor.

I think of ghrelin as making me.

Hungry, Hungry and angry.

Why would I want to take something that would increase ghrelin signaling?

Some people are trying to gain weight. It also does increase your growth hormone. So if your growth hormone is very low, you can consider it. Ibutamorin is a long acting, so it has a long half life. Also known as MK677. It was, well, it was studied mostly in growth hormone deficiency.

And do these people get angry also?

They can. Many people report a side effect of anxiety or significant hunger. Most people take it in the evening, so they don't notice that hunger as much. It can also greatly increase your blood glucose. So if you're insulin resistant or pre diabetic, it's especially concerning.

This is one of those rare moments where I hear something and I think, okay, even though there's this kit of compounds that can increase GH and IGF one, based on everything you're telling me, maybe just taking GH is the better option for those people because growth hormone, at least it's synthetic growth hormone, is mimicking an endogenous hormone. I mean, certainly not taking anything might be the ideal. But for those that want to increase growth hormone and they want to use pharmacology to do that, sounds like these peptides are pretty precarious.

Yeah, it kind of depends on the situation. If there's a. An individual that struggles with hunger and not eating enough, for example, you know, someone who has a very small stomach or they just have a very low hunger drive, sometimes you want more of that rexigenic signaling. The hypothalamus, you have anorexigenic signaling, which is kind of like anorexia and orexigenic signaling, which is, I call it the hangry center of the hypothalamus. Or the hangry center. And if there's an imbalance between those two, then perhaps it'd be helpful, potentially theoretically helpful in anorexics, of which the incidence of anorexia in men is increasing significantly.

As you're telling me this, I'm remembering being 14 or 15 years old and I would go into the kitchen sometimes and I was so hungry I would just obliterate all the food. And I do remember being. I've always been a pretty high energy guy, but having an immense amount of energy. I can't recall if it was a hangry feeling or not, but I'm guessing that was growth hormone. I grew one foot in a single academic year, so I imagine that was at least in part due to growth hormone. In any case, sermorelin is the peptide that I hear most often about. I admittedly tried a run of it. I was researching a book and decided to take it before sleep on an empty stomach. It gave me a tremendous depth of sleep, but that sleep was really truncated, which is just nerd speak for saying deep but short sleep. I would wake up after very intense dreams. I can't say that it helped me recover from exercise that much. I didn't notice any additional fat loss or anything. Sort of abandoned it except for occasional use. Again, this was prescribed by a doctor. You know, I'm starting to get the sense that these peptides and their effects are somewhat vague and distributed and highly individual. Is that a fair way to describe them?

Part of the problem with the effect of peptides is many people take them in levels that are far above the physiologic range. Even individuals who are checking their IGF1 while they take these different GHRPs, most of them do not check the binding peptides, for example IGF Binding Peptide 1, 2 or 3, and their free IGF1 level might be significantly different. So the common doses that people will take these off label for as a supplement are often much greater than the therapeutic or physiologic range, which for me.

Just underscores the fact that it's pretty precarious. I mean, I'm not coming in here as the referee of what anyone should or shouldn't do, just trying to gather and distribute information. But I've heard, for instance, that some companies where people can acquire these things without prescription, those companies are not good at cleaning out the lipid polysaccharide, the lps, which can cause an inflammatory response. In other words, these are dirty compounds. And that just sounds risky. It just sounds. Frankly, it just sounds really dangerous.

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

Yikes, yikes and yikes. But I tend to be pretty conservative when it comes to taking anything exogenous. But I do rely on many of the supplements that we talked about earlier, and I do try and optimize the behavioral things and nutritional things for a long time. Okay, so then leaving peptides behind, we are now, I suppose, in the territory of exogenous hormone. So let's say that somebody decides they're not concerned with fertility or they're going to bank sperm, or they already have kids, or they're going to defer on this issue of wanting to have kids. My understanding is that nowadays a lot of people are using testosterone, let's not even call it replacement therapy, because some of These people have 600, 700 or even, you know, 800 nanogram per deciliter read. So they're not replacing anything that is diminished. They're just trying to augment what's already there, increase what's already there. My understanding is that taking a low dose more frequently is going to be more beneficial than the kind of old school way of Giving, you know, 100 or even 200 milligrams in a single injection once every two weeks, is that right? And what do you do with your patients? So let me give you a hypothetical. Somebody comes into your office, they do their blood work and they have blood levels of, let's say, 600 nanograms per deciliter testosterone. Their estrogen is also in normal range. Everything else checks out, but they're complaining of slightly diminished libido, slightly poor recovery from workouts, maybe reduced motivation and drive, although no major depression. And you come to the conclusion that testosterone therapy, not replacement, but testosterone therapy might be a good option to explore. What's a typical dosage range and frequency of administration range that you might consider exploring?

And some of this depends on the SHBG and free testosterone as well. So if that same individual had a very high shbg, which again is the binding protein that binds up the testosterone and all androgens and estrogens, if it is Extremely high and they have a free testosterone of 2, then they might need a different dose because they need enough testosterone in order to have a normal eugenadol. Free testosterone, but a general normal dosing range, especially for someone starting, is around 100 to 120 milligrams divided over the course of a week, usually either every other day or three times a week, occasionally twice a week. Many people with SHBG a bit higher can get away pretty easily with twice a week. This is assuming that the ester is cypionate or ananthate.

SO2 60 milligram injections of testosterone cypionate per week.

Yeah, very common dosing to hit that.

120 milligrams per week as kind of the typical average. Correct.

And I would consider this like a physiologic eugenadal dose. For many people, even 200 milligrams a week is far above the reference range. All of this is said with the caveat that testosterone is normally released in a pulsatile manner. So it's high in the morning, low in the evening. Whereas if you're on testosterone therapy, then you're going to have a steady state. So your testosterone level is going to be pretty much the same even in the evening.

And in your experience, when patients do that, they, I'm guessing they report the normal constellation of positive effects. You know, improved mood, improved energy, improved sleep recovery, et cetera. What are some of the hazards or things that can crop up in blood work or just subjectively that can be warning signs that even a dosage of 120 milligrams divided into these two or three dosages per week is too high.

Every organ system in the body. So this is when you really have to be at least well versed in every organ system, not just the gonadal, like, you know, genital system. You need to have, you know, dermatology prowess. Acne is a very common change. Lots of different skin pathologies or even bruising can be related to hormone replacement. Hair loss is very common to see as well. Mental status changes. It could occasionally it even induces a manic or a bipolar episode because testosterone is also dopaminergic. And then cardiovascularly not just in the heart, but also concerns for like microvascular ischemic disease, ferritin buildup because the estrogen also increases. And then fertility concerns as well, and lipid concerns too. So you really have to be hematologist, dermatologist, cardiologist, lipidologist, the whole nine yards.

So another reason or set of reasons rather to if one is considering using testosterone therapy, to really do this in close communication with a really good physician. Because that's a lot to monitor. Knowing whether or not you have acne or not is one thing, but knowing whether or not your LDL is going up, your apob is going up, that's a whole other biz and that needs to be done through blood work is what I'm hearing.

Correct. And if your physician that is managing or prescribing your testosterone therapy or your HRT is not well versed in these systems, you would want him or her to be part of an interdisciplinary team where they have other experts that can monitor those systems.

I skipped over a sort of still intermediate set of things, prescription drugs. But maybe talking about testosterone first was a bit of a mistake on my part because I'm aware that there's a. Actually, I think there are companies, but certainly groups out there that say, no, wait, don't go straight from nothing to supplements to testosterone. Once you're doing behaviors and optimizing nutrition supplements, let's forget peptides instead of going straight to testosterone therapy. One idea that many people are pursuing is to take the prescription drugs that trigger luteinizing hormones. So taking hcg, human chorionic gonadotropin, estrogen, which my understanding is will increase testosterone but also estrogen, or they'll take things like clomiphene. In fact, I think there are a bunch of companies out there now that are saying don't take testosterone. It shuts down spermatogenesis, shuts down testosterone production. Clomiphen is the way to go. Maybe you could educate us about the HCG monotherapy, I think it's called, where you're just mono one just taking HCG and clomiphen as a. Andor clomiphen as a tool to ratchet up hormones.

So quick points on hcg, human chorionic in atropin made during especially the first trimester of pregnancy, it has effects other than binding to the LH receptor. It also binds to the TSH receptor in the thyroid.

Thyroid stimulating hormone.

Yes. In fact, if you look at a molecule of HCG and thyroid stimulating hormone, they are extremely similar. However, you need a relatively high dose of HCG to bind to the TSH receptor. This is the normal mechanism in pregnancy that accounts for the increased need of thyroid hormone, usually about 30 to 40%. So that's why if someone has hypothyroidism, you need to increase their dose of thyroid because the HCG is not going to be Doing it for you. The Clomid or Clomiphen, there's two main, I believe it's diastereoisomers, and one of them is enclomiphen, One of them is zoo clomiphen, and these two work slightly differently. Enclomiphen, I believe, has a faster half life and it is potentially slightly better tolerated. However they were studying it, you know, Clomid is a very commonly prescribed drug and obviously there is plenty of enclomiphen in Clomid. However, the drug, which was Androzole A N D R O xal, did not go all the way through the FDA approval process despite Clomid being FDA approved.

Okay, so there's Clomid, which contains Clomiphen, but there are also, because we're talking about men hormone, male hormone optimization. This episode, there are males out there who want to increase their testosterone and other hormones, maybe growth hormone, et cetera, who opt to not take exogenous testosterone. So no cream, no pellet, no pill, no injectable cypionate, but decide to take Clomiphen a couple times a week. My understanding, I've never done this. I would say if I had. My understanding is that taking Clomiphen, maybe two 50 milligram tablets a week is what I hear people are doing. Will increase what? Luteinizing hormone, the various estrogen receptor subunits. Could you explain how clomiphen would benefit anyone and is this a good strategy? I'm hearing that it's being done quite a lot now.

Now, it will increase testosterone in a dose dependent manner, but it has many other pharmacodynamic effects, which is the effect of the drug on the body other than its effect on the hypothalamus and the pituitary. So in the hypothalamus and the pituitary, it does what's called negative feedback inhibition, or it, it blocks the oxygen of estrogen. So it crowds out estrogen from the estrogen receptor on the hypothalamus and the pituitary.

And what's the subjective effect that that would cause? So my understanding and experience of estrogen is that if I ever took, and I did take a very low dose of an aromatase inhibitor once, and I felt terrible, actually reduced libido, joints felt achy. That's when I discovered that, wow, estrogen is actually really important for your brain function, for joint function and for libido. And suppressing estrogen for me just turned out to be the, the wrong idea. But my levels indicate that it's within reference range. Okay, so why would I want to take something that would increase the activity of an estrogen receptor? I just can't find the rationale for that.

The main rationale behind taking a CIRM is as a very temporary measure that is not going to suppress pituitary or hypothalamic function if your testosterone is just so drastically low that it is unlikely to recover anything. Anywho. Anyway, so most of the time it is not clinically useful. And CIRM should not be prescribed very often, certainly not as long term testosterone replacement or testosterone optimization. In most individuals there's always exceptions to everything. But there's five different estrogen and estrogen related receptors. There's two main estrogen receptors and Clomid. And every CIRM has a very unique profile because they selectively inhibit some receptors in some tissues but not other receptors in other tissues. For example, Clomid can inhibit receptors that are in the eye and it can cause visual changes, blurry vision, especially at higher doses. And it also acts in every other tissue of the body. So side effects from Clomid and other selective estrogen receptor modifiers are very common.

So I'm, at least by my mind I'm going to pool them with peptides and say it sounds precarious and probably not ideal for most people. Going back to testosterone therapy. Then again, notice folks, I've deleted the replacement part because I think so many people are using testosterone therapy without the need to the, the sort of reference range, need to replace anything, but rather building on what they already have for purposes of increasing vitality, et cetera. Going back to that, my understanding is that taking HCG several times per week can help maintain spermatogenesis and fertility even while people are on testosterone. But, and you and I were talking about this earlier, that there's tremendous variation. Some people will take a small amount of testosterone and just crush their sperm count. They just won't make any viable sperm. Other people can maintain viable sperm sperm production while on testosterone, especially if they're taking hcg. Is that right?

Correct. And there's many reasons for this. Some of this has to do with heat damage to the testes. So potentially cold therapy could be helpful for that.

And ice baths, cold showers.

Yeah.

Or just avoid, and certainly avoiding sauna. Yeah, yeah.

Stopping the daily hot tub can restore fertility in many people.

I know a number of people, people that are trying to conceive children that go into the sauna and they'll just put a cold pack in their shorts or between their legs, depending on Whether or not they're wearing shorts or not.

When they go in.

Or they'll alternate ice and heat in a way that maintains coolness of the milieu in which the sperm live. In other words, they're cooling their scrotum deliberately in order to avoid killing. Actually I saw an interesting paper that said that for every 2 degree increase in temperature of the scrotum there's a 20% decrease in spermatogenesis and viability of sperm. And that actually if you look at the difference between people who stand a lot, sit a lot and drive a lot, what you see is a progressive decrease in sperm count because when people are sitting there's an increase in temperature and then when they're sitting on the highway hot seat of the car, there's an. Or using the heated seats actually kills sperm. I think there are good data on that.

Yeah, excellent data. And anecdotally you see it as well. I've had several patients come in for fertility consultations and all we do is like, you know, no medications, no supplements. We change their like several lifestyle things, very tight fitting clothing is another one. And soon they have fertility and they're no longer they, they have sperm whereas before they did not.

Interesting. Like to talk about some of the do's and don'ts, but we have talked about a lot of do's, things that one can do to optimize hormones. Maybe we could just do sort of more rapid fire Q and A on some of the don'ts and maybe throw in some science where you feel it's appropriate. Cannabis? Marijuana. Thc, yes or no? It diminishes testosterone levels.

Smoked cannabis, I would say diminishes testosterone, increases prolactin. That's a. No other cannabinoids, not particularly harmful. So cbd, cbd, not particularly harmful. Smoked cbd. I'm not sure.

What about edible cannabis and thc?

As far as I know, edible cannabis and THC does not significantly increase prolactin to a point where it would be disruptive of hormones.

Can marijuana, thc, cannabis, whatever you want to call it, increase gynecomastia, the growth of male breast tissue?

Yes, it certainly can. And there's a pretty good association between smoked THC and gynecomastia.

What about nicotine and testosterone and estrogen and other hormones? Smoked nicotine?

Nicotine is particularly concerning not only for testosterone but also for estrogen. Part of it is, if you're talking about nicotine from tobacco, there's many other carcinogens in it, especially if it's smoked. But Nicotine, even if it is chewed in a dose dependent manner. So if you can use an extremely small amount of nicotine, then it's not as concerning in the long run. But it's a vasoconstrictor and one of the main concerns with it would be cardiovascular disease or even microvascular ischemic disease that can lead to neurodegenerative disease. So like a type of dementia that can be partly due to nicotine. If you use nicotine for a very long period of time, especially at a higher dose, it's a dose dependent effect on your hormone profile.

Is that also true for nicoragin, nicotine, other nicotine gums at high doses?

If you can use an extremely low dose of a nicotine gum, then theoretically that would be, you know, maintainable. It's not going to overload the nicotinic receptor. You have acetylcholine and the cholinergic system is one of your, you know, main nervous systems, of course, and you have muscarinic receptors and nicotine receptors. And there's just better ways to optimize your nicotinic receptor activity. For example, acetylcholine precursors like alpha gpc, phosphatidylserine, phosphatidylcholine, weak acetylcholinesterase inhibitors, especially natural ones, potentially have a like a part as well, and then other alkaloids. So nicotine is an alkaloid from the tobacco plant. There's other plants like cytosine and the, that genus of plants. And that alkaloid is also a nicotine receptor agonist.

Is it true that cycling for too long, literally bicycling, sitting on a bike seat too long, can damage the prostate?

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

So we were talking earlier today in the gym about how heavy leg work, hack, squats, deadlifts, those kinds of things a lot of guys are doing to increase their testosterone. Done correctly can actually augment and build up the strength of the pelvic floor. Done incorrectly can actually weaken the pelvic floor and Lead to all sorts of issues, including sexual effects, negative sexual effects. So how does one go about learning whether or not their movements are being done properly to support pelvic floor or to destruct pelvic floor?

The pelvic floor is a constellation of muscles, just like any other kind of like system in the body. And you know, form is important. If you're doing the Valsalva maneuver, which again is that kind of like bearing down or deep breath where you feel all of your abs are tight, you can also notice that your pelvic floor is tight as well. If you have a history of an inguinal hernia, which is a hole kind of like connecting the abdominal cavity down through the pelvic floor or even the scrotum in some cases. And that can be a sign that there is weakness in that area and you might have to concentrate it on it. Most or even have a physiotherapist or a physical therapist specifically target the pelvic floor. Many exercises in which you valsalva or use your glutes or legs, you can learn to squeeze them and have that mind muscle connection in order to help build up the pelvic floor. And there's other things many people are familiar with Kegels, that is just one of the many different exercises that can help your pelvic floor.

My understanding is that while strengthening the pelvic floor is good, excessive contraction of the pelvic floor can actually limit blood flow to the pelvic area, the penis and so forth. So this is again, it's a double edged sword, right? I mean, you don't want guys out there to just start doing endless number of Kegels every day because they're actually going to constrict blood flow to that area. Right? And in fact the erection response is parasympathetic. It's a relaxed induced response, right?

Correct.

So, you know, the reason I chuckle is that for because we're talking about things, we don't have visuals or charts. And certainly it's hard to know whether or not a given exercise like Kegels are going to be good or not good. If it's excessive, how many sets and reps does it take before it goes from good to bad? Is there a kind of general rule of thumb for people to think about this? I mean, clearly blood flow to that area is key for sexual performance. And yet when one trains the legs or even walks, you're getting blood flow. So my understanding is this, that a combination of weight training to stimulate the positive hormonal and muscular and connective tissue growth is key, provides not over training, but so is casual exercise like walking and stretching and the sorts of things that will then return blood flow to that area. Is that a, an overly basic way to think about it or will that suffice?

I think that's a good way to think about it. I think the main point with Kegels is they're just a one of many different things. So if you're having some pelvic floor pathology, certainly, or even just concerned about your pelvic floor, don't just, you know, take the advice. Do Kegels and you'll be okay. That is not near enough. It's just one of the many aspects.

Okay, so going back to the rapid Q A and then we'll come back to this issue of blood flow because there's some interesting science and protocols there. The question I have is alcohol. Does it increase aromatase, the enzyme that converts testosterone into estrogen, or not? And is there a dose dependence there?

It significantly does. There is a dose dependence. In general, I would not recommend more than three to four standard drinks. One huge glass of wine is probably five standard drinks, but I'd say every two weeks.

Yeah, that's consistent with what I discovered researching alcohol in an episode we did on alcohol that no, alcohol is definitely better for all aspects of health than any alcohol. And anyone that says that, well, red wine contains these various things. Well, it doesn't contain enough of those positive things to have a positive effect. But that if people do opt to drink alcohol, that two drinks per week, meaning 20 grams of alcohol, so that's probably two 12 ounce beers or two 4 ounce glasses of wine is going to be the upper limit, beyond which you're going to start seeing all sorts of negative effects.

The other thing to keep in mind with alcohol is it has a lot of calories, 7 kilocalories per gram, almost as much as fat, which is 9. And then it's also very GABAergic, so it can activate inhibitory neurotransmission. And that can also affect how many, how much LH and FSH is released. So that can also decrease testosterone. Almost kind of similar to how opiates can decrease testosterone.

I feel very lucky that I don't enjoy alcohol. Never really did. Can kind of take it or leave it. Certainly don't like sedatives like Valium or anything like that, which as you just mentioned, can suppress testosterone. You said the word fat. So I'm going to pick up on that and say in order to Optimize hormone production. Is it important to have some saturated fat in one's diet and what happens on very low fat diets to testosterone, estrogen and other steroid hormones?

Fat's interesting because there's so many different beneficial fats. Omega 3s. Almost every American gets plenty of Omega 6s in any developed country, really. When it comes to saturated fat, there is more of a correlation with hormone optimization. If you're eating things with saturated fat fat you tend to have those are things with more, you know, fat soluble vitamins and things that are very nutrient dense otherwise. But it is not vital in general, you want to eliminate any trans fat unless it's trans fat from the ruminants. There's always an exception to everything, right? So there is healthy trans omega 3 fats which are formed in the stomach of like grass fed and finished ruminants.

But ingesting more, mostly olive oils, maybe nut butters in limited amounts because they're very calorie dense. But unless people are trying to increase their calories, in which case they're a great source of calories, small amounts of butter or ghee probably okay, but not excessive amounts. Is that the idea?

Yes, fat is perfectly fine. Cholesterol has an interesting. So cholesterol and in general phospholipids make the bilayer that's around the cell. But cholesterol is also a hormone in and of itself because it binds to the estrogen related receptor alpha. So I consider that like in the estrogen receptor category and that can help with metabolism, but also potentially have concerns for cancer and tumor risk.

I want to go back to the prostate and talk to you about something that's kind of a newer emerging trend. I know that you've talked a little bit about this in previous podcasts, that a number of men, I should say a number of physicians, are prescribing low dose tadalafil, also known as cialis, to their male patients. So in dosage ranges of like 2.5 milligrams to 5 milligrams per day. But not for erectile dysfunction, but rather for improving prostate health. And presumably they get sort of a boost in terms of blood flow to the genitalia as well, but again, not specifically a deal with with erectile dysfunction, but to deal with prostate health and blood flow to the prostate. Is that something that you sometimes often prescribe to your patients and of what age?

Tadalafil is a very underrated medication. The age would kind of depend on the indication. So tadalafil is also a Blood pressure medication, it can very slightly decrease blood pressure, especially at higher doses. At higher doses it a high dose would be 20mg, not 2.5mg. But consistently it can somewhat affect with the cones in the eye that have to do with red and green sight, although if you remove it, that effect is reversed. So basically, if you don't need really, really good red green discrimination, you can take higher doses. But in general I recommend no higher than 10 milligrams a day, usually just 2 or 5 milligrams. One other benefit or other use of Tadalafil is that it increases the density of the androgen receptor, similarly to L Carnitine. So that's an interesting benefit. Another benefit is that if you give it to people with nocturia, which is urinating at night, in general, it will cut the episodes in half. So it could go from two to one, which can make a big difference for your sleep, which will secondarily make a big difference difference for your growth hormone and testosterone optimization.

Interesting. So you said 2.5 to 5 milligrams per day is typical for these prostate enhancing effects.

Yes.

And you mentioned the potential side effects on adjusting visual perception. As a vision scientist, that rings in my mind. But in terms of red green color discrimination, I'm guessing unless you're going to be a subject in one of the experiments in my lab or you want to be a fighter pilot, chances are you can probably get away with a little less red green color discrimination.

Correct. It's not considered clinically significant unless someone is a commercial pilot.

Great.

So if someone's getting their like pilot exam, that's one of the things we look for.

Okay, so commercial pilots aside, you might want to ask your doctor about low dose tadalafil for sake of enhancing prostate health, certainly monitoring PSA prostate specific antigen is important. I can give an anecdote there. When I tried Sermorelin, one of the surprising side effects that was was not welcome was a dramatic spike in my prostate specific antigen. No one could explain to me why that would happen. But when I stopped taking Sermorelin it went back to normal. So it's one reason I avoid Sermorelin. At least frequent use of Sermorelin PSA should be kept what below levels of, you know, somewhere between 1 and 4 is considered healthy, is that right?

It depends on the age. If there's a 20 year old, likely between 0 and 1. If there's a a 40 year old, likely between 1 and 3. And then if there's an 80 year old, it would not be abnormal to have a PSA of 5 and have that be well within the reference range.

Right.

Another thing we should mention about PSAs. If you do take a 5 alpha reductase inhibitor like finasteride or dutasteride, often these will cut your PSA in half. So if you, for example, if you have a PSA of 6 and you start finasteride or dutasteride and then you recheck it in six months and it's 6.5, that is a huge concern because that's actually doubled.

I'm glad you brought this up because I almost overlooked the fact that I get a lot of questions about drugs to offset hair loss. Most of those drugs are going to operate through the DHT system, the dihydrotestosterone system, for the reasons we talked about before, DHT receptors being on the scalp and causing beard growth on the face. Is it the case that a number of people taking things like propecia and other things to block the DHT or disrupt the DHT pathway are going to experience diminished sex drive, diminished kind of motivation and general vigor? And if so, are there alternatives like topical DHT antagonists that they might use if they want to keep their hair but not have those negative effects?

The way that I think about hair loss is you have your fertilizers, also known as a growth agonist, and then you have your anti androgens, whether they're systemic or topical. There is both, but that's the general layman's way to think about hair loss. If you're only putting fertilizer in your hair, but you have androgenic alopecia or male pattern baldness, then those hairs will still miniaturize and eventually you'll still have loss.

Such a great word, miniaturize. Yeah, it's enough to send anybody off to find a therapeutic.

And by the way, it's difficult to tell if miniaturization is happening unless you have a magnifying glass you can use.

A note for a second there, I didn't know whether or not you were making a joke. You're talking about miniaturization of the hair follicle, correct?

Yeah.

So what can reverse that? Miniaturization. That's just a fun word to say. I'm going to just keep saying it.

Each individual has, again, we mentioned the androgen receptor. Males only have one androgen receptor gene. It's on their X chromosome. So depending on how sensitive that androgen receptor is and depending on the density of the Receptors in the hair follicle, you can have a arbitrary threshold and you don't know what this threshold is until you start to have miniaturization and loss of hair. But over the threshold the follicle will die and eventually the stem cell will leave. But under the threshold you're okay. Every androgen binds to the same androgen receptor. So there is nothing special about Dharma. DHT is just a stronger androgen. So the higher your shbg, things that increase SHBG are beneficial for hair loss prevention because you have less binding of that receptor. So if you think about hair loss specifically androgenic or male pattern baldness in the terms of that androgen receptor and everything in general binding to it, not just DHT but also testosterone, it's helpful. Are beneficial for hair loss prevention because you have less binding of that receptor. So if you think about hair loss specifically androgenic or male pattern baldness in the terms of that androgen receptor and everything in general binding to it, not just DHT but also testosterone, it's helpful. It's just that DHT is a huge battering ram, whereas the other androgens are just light presses on the door. It's just that DHT is a huge battering ram, whereas the other androgens are or just light presses on the door.

Got it. So are some of the topical DHT receptor antagonists going to be a better choice for people that want to maintain their hair, grow more hair if they want to avoid side effects? Got it. So are some of the topical DHT receptor antagonists going to be a better choice for people that want to maintain their hair or grow more hair if they want to avoid side effects?

Likely. So some individuals benefit from systemic a systemic decrease in DHT for a couple of reasons. One could be prostate and then one could actually be hypertrophy likely. So some individuals benefit from systemic asystemic of the myocardium. So DHT also disproportionately thickens the ventricle. So for someone on trt, that might be a benefit that is prone to thickening of the ventricle at baseline. However, recent DHT for a couple of reasons. One could be prostate and then one could actually be hypertrophy of the myocardium. So DHT also disproportionately thickens the ventricle. So for someone, many people that have just a bit of predisposition, they can use things that are topical anti androgens. Ketoconazole is one of them. Caffeine is actually Another one on trt that might be a benefit that is prone to thickening of the ventricle at baseline.

However, drinking caffeine.

Topical caffeine?

Oh, I was gonna say my hair tends to grow pretty fast, so maybe, but I drink a lot of caffeine. So topical caffeine really rubbing coffee on their head or. Or taking caffeine tablets.

And how does many people that have just a bit of predisposition, they can use things that are topical.

Wait, you have to explain how this works. How do people get caffeine into the hair follicles?

Topically, the caffeine enters the scalp and crowds out like somewhat crowds out the androgen antiandrogens. Ketoconazole is one of them. Caffeine is actually another one.

Wait, drinking caffeine?

Topical caffeine?

Oh, I was gonna say my hair tends to go pretty fast, so it might be that. But I drink a lot of caffeine.

So it is a weak effect. It's likely just strong enough to be clinically significant. Usually caffeine is put into formulations with other things like keto topical caffeine.

Really rubbing coffee on their head or. Or taking caffeine tablets.

And how does all that are also weak anti androgens. Of note, spironolactone can be prescribed topically, but is it is absorbed systemically because the size of the molecule. So unless your doctor.

Wait, you have to explain how this works. How do people get caffeine into the hair follicle?

Specifically prescribes that for you, especially as a male. Do not use topical spironolactone. Topical finasteride is also a smaller molecule, so it is topically the caffeine enters the scalp and crowds out like somewhat crowds out the androgen, also systemically absorbed, but it is not extremely well systemically absorbed. If you take topical finasteride, then usually your systemic DHT will decrease by about 30%. Topical dutasteride is likely a tiny bit systemically absorbed, but it's unique because it's. Its half life is much faster at a lower dose. So topical DUT is a weak effect. It's likely just strong enough to be clinically significant. Usually caffeine is put into formulations with other things like ketocon. Pasteuride will not affect your systemic DHT at all. And I've seen this anecdotally on many people on topical dutasteride therapy.

We're gonna have to get you back on here and do an episode all about DHT and hair loss and hair.

Growth that are also weak anti androgens of notes. Spironolactone can be prescribed.

You know, again, not a topic that I focus on a lot for myself, but that I get a lot of questions about for men and women.

One thing that we could mention, I got a ton of questions about turmeric and curcuminoids after last episode described topically, but is it is absorbed systemically because the size of the molecule. So unless your doctor specifically prescribes that for you, especially as a male, do not use topical spironolactone. Topical finasteride is also a smaller molecule, so it is also systemically absorbed, but it is not extremely well systemically absorbed. If you take topical finasteride, then usually your systemic DHT will decrease by about 30%. Topical dutasteride is likely a tiny bit systemic.

Oh yeah. But I had reported my own anecdotal experience that taking turmeric really crushed my DHT levels and I did not feel good. I mean it crushed all sorts of positive feelings of vitality. The moment I stopped taking turmeric felt great again.

Many people report this and the interesting thing about turmeric is most of its beneficial action, not all of it. Some people benefit from systemic turmeric and some people that can tolerate it well, it's actually great for the prostate, but most of the action it does not need to be bioavailable. It acts on the gut microbiome. So you can take turmeric and if it is not absorbed, some turmerics is put in special formulations like micellar liposomal fully absorbed. But it's unique because it's half life is much faster at a lower dose. So topical or complex. But a lot of it is put with black pepper fruit extract which is also known as biopurine, which is actually also a 5 alpha reductase inhibitor. And itafasteride will not affect your systemic DHT at all. And I've seen this anecdotally on many people on topical lutesterone tried therapy.

We're gonna have to get you back on here. Do an episode all about DHT and.

Hair loss and hair growth, liver cytochromes and so many supplement companies put this black pepper fruit extract biopurine in almost everything. So some people are on really high doses and that could also be making.

You know, again, not a topic that I focus on a lot for myself, but that I get a lot of questions about for men and women.

Most of the effect of people who, who do not tolerate turmeric well, yeah.

I avoid turmeric like the plague based on that one previous experience because it was clearly turmeric.

One thing that we could mention, I got a ton of questions about turmeric and curcuminoids after last episode that caused.

The negative effect coming off it, everything reversed rapidly. And the biopurine, the black pepper extract, I also avoid that like the plague based on everything you just said. I want my five alpha reductase. Oh yeah. I had reported my own anecdotal experience that taking turmeric really crushed my DHT levels and I did not feel good. I mean, it crushed all sorts of positive feelings about my DHT to be optimized simply because my understanding is DHT is the more powerful androgen and it's the one that, yes, it causes a little bit of hair loss and I've got a few, you know, vitality. The moment I stop taking turmeric felt great again. Patches here and there. But I'm willing to live with that based on all the other wonderful things that DHT optimization does.

I'll quickly mention a few other things. One saw palmetto is also a 5 alpha reductase inhibitor. But only a couple of the many people report this. And the interesting thing about turmeric is most of its beneficial action not isoenzymes. There's three main isoenzymes and a lot of the problem is that you're inhibiting a couple of the isoenzymes but not the other one. Finasteride inhibits all of it. Some people benefit from systemic turmeric and some people that can tolerate it well. It's actually great for the prostate, but most of the action it does not. 1 and 2 dutasteride actually inhibits all three and finasteride inhibits the isoenzyme that is in genital skin but not in the skin throughout the rest of your body need to be bioavailable. It acts on the gut microbiome. So you can take turmeric and if it is not absorbed, some turmerics is put in special formulations like micellar or liposomal body. So a lot of the side effects of finasteride, which is loss of sensation and loss of erectile function, have to do with the disconcordance between the sensitivity of the genital skin and the skin.

Again, another reason to not disrupt 5 alpha reductase. And we'll definitely get you back on here to talk about. I think we should just do a who whole episode about dht because so.

Often when people or complexed But a lot of it is put with black pepper fruit extract, which is also known as biopurine, which is actually also a 5 alpha reductase inhibitor.

And it we're thinking about optimizing hormones, especially male males trying to optimize their hormones. They're thinking testosterone, testosterone. Maybe nowadays they think a little bit more about free testosterone and maybe they think about estrogen is also being important not to crush estrogen. But DHT is, you know, at least to my mind, the linchpin of so many of the things that subjectively people are really focused on. Libido, motivation, drive, et cetera, liver cytochromes.

And so many supplement companies put this black pepper fruit extract biopurine in almost everything. So some people are on really high doses. And that could also be making.

I have one final question. It's just a brief one, but many of us have heard that the BPAs that are present in, you know, plastic bottles and even in certain aluminum cans and phthalates. A difficult word to pronounce, but a fun one nonetheless. Phthalates. And work by Dr. Shana Swan has shown that phthalates exposure to the fetus, to pregnant mothers and to fetuses.

Most of the effect of people who do not tolerate turmeric.

Well, yeah, I avoid turmeric like the plague based on that one previous experience because it was clearly turmeric that caused the negative effect coming off it. Everything very likely is negatively impacting sperm counts, testosterone levels and even changing genitalia size for the worse in males nowadays. I saw a beautiful lecture that Dr. Shana Swan did on this when I was in Copenhagen and it's very clear that it's negatively impacting the male fetus. She was also on Joe Rogan's podcast. I hope to get her on this podcast. However, what she couldn't answer reversed rapidly. And the biopurine, the black pepper extract, I also avoid that like the plague. Based on everything you just said, I want my 5 alpha reductase, I want my DHT to be optimized simply because my understanding is DHT is for me was whether or not phthalates and BPAs and these things present in plastics and some people even claim in tap water are bad for males after they're born and after puberty. What are your thoughts on. Or I should just ask you, do you drink water out of plastic bottles? Do you avoid drinking out of cans that are not specifically non BPA containing cans? And do you the more powerful androgen and it's the one that yes, it causes A little bit of hair loss and I've got a few, you know, patches here and there. But I'm willing to live with that based on all the other wonderful things that DHT optimization does. Actively avoid phthalates. My understanding is that phthalates are most enriched in pesticides and that's why you're seeing dramatic drops in sperm and testosterone levels, mainly in rural areas where they're dust cropped.

Yeah. So I do avoid drinking out of cans that are plastics that may have BPA or bisphenol A in them. Bisphenol A is known to bind to what I would consider. I'll quickly mention a few other things. One saw Palmetto is also a 5 alpha reductase inhibitor, but only a couple of the isoenzymes. There's three main isoenzymes and a lot of the problem is that you're inhibited to fit. Fifth estrogen receptor, estrogen related receptor gamma. So it, it I would, I would consider it a xenoestrogen. So phytoestrogens are estrogens from plants and in general they're not concerning or clinically significant and xenoestrogens are just other estrogens. So I do avoid bpa. And I also test my water by using a couple of the isoenzymes, but not the other one. Finasteride inhibits 1 and 2, dutasteride actually inhibits all three. And a water testing service, and I test it both after it's through my water filter and the tap water that my two boys drink almost every day. And it was very interesting. I only found one microplastic just a bit over the reference range. So it wasn't a terrible tap score. But even in developed countries these are widely variable as far as phthalates. Finasteride inhibits the isoenzyme that is in genital skin, but not in the skin throughout the rest of your body. So a lot of the side effects of finasteride, which is loss of sensation and loss of erectile function, again, very difficult and interesting to pronounce. But I remember learning about these because there was, I believe, a lawsuit that had to do with Mac and cheese. And this was probably five years ago and I was coming up with my list of each provider that does obstetrics has a list have to do with the disconcordance between the sensitivity of the genital skin and the skin.

Again, another reason to not disrupt 5 alpha reductase. And we'll definitely get you back on.

Here what to avoid for the pregnant lady. You know, sketchy deli meat or high mercury fish like swordfish and salmon. And I actually added processed Mac and cheese to that list.

Interesting. Well, thank you for that. I'm going to extract your statement that you avoid drinking out of plastic bottles when, when possible. I'm guessing you're not neurotically attached to that. If you're dying of thirst, you might talk about I think we should just do a whole episode about dht because so often when people are thinking about optimizing hormones, especially male males trying to optimize their hormones, they're thinking testosterone, testosterone. Maybe nowadays they think a little bit more about free testosterone and maybe they think about estrogen as also being important. Not a plastic bottle of water to survive, but listen to crush estrogen. But DHT is at least to my mind, the linchpin of so many of the things that Kyle Dr. Gillette, thank you so much. You gave us an enormous wealth of knowledge, everything from behaviors to psychology to supplementation to prescription drugs. We will make sure to point out where people can get a hold of you on Instagram and on Twitter and on other subjectively people are really focused on libido, motivation, drive, et cetera. Websites in our show. Note captions, but really just on behalf of the audience and just for myself, I have one final question. It's just a brief one, but many of us have heard that the BPAs that are present in plastic bottles and even in so much, you have an immense amount of knowledge and you're exquisitely good at sharing it with people in an actionable way. So thank you.

My pleasure.

Thank you for joining me today for my discussion with Dr. Kyle Gillette. All about male hormone optimization. Certain Aluminum cans and phthalates. A difficult word to pronounce, but a fun one nonetheless. Phthalates and work by Dr. Shana Swan has shown that. I just want to remind everybody that we will soon have an episode all about about female hormone optimization. If you're learning from and are enjoying this podcast, please subscribe to our YouTube channel. That's a terrific zero cost way to support us. In addition, please subscribe to the podcast on both Spotify and Apple. And on both Spotify and Apple you can leave us up to a five star review. If you Latex exposure to the fetus, to pregnant mothers and to fetuses very likely is negatively impacting sperm counts, testosterone levels and even changing genitalia size for the worse. You have questions for us or comments about the podcast or guests that you'd like me to interview on the Huberman Lab podcast. Please put those in the comments section on YouTube. We do read all the comments. In addition, please check out the sponsors mentioned at the beginning and throughout today's episode. That's the best way to support this podcast. If you're not already following Huberman Lab on social media, we are Huberman Lab on all platforms. So that's in males nowadays. I saw a beautiful lecture that Dr. Shanna Swan did on this when I was in Copenhagen and it's very clear that it's negatively impacting Graham, Twitter, LinkedIn and Facebook and all of those places. I describe science and science related tools, Some of the male fetus she was also on Joe Rogan's podcast. I hope to get her on this podcast. However, what she couldn't answer which overlap with the contents of the Huberman Lab podcast, but much of which is distinct from content on the Huberman Lab podcast. So again, it's Huberman Lab on all social media platforms. During today's episode and on many previous episodes of the Huberman Lab podcast, we discussed supplements. While supplements aren't necessary for everybody, for me was whether or not phthalates and BPAs and these things present in plastics and some people would claim in tap water are bad for males after they're born and after puberty. What are your thoughty? Many people derive tremendous benefit from them for things like sleep hormone augmentation and focus. If you'd like thoughts on Or I should just ask you do you drink water out of plastic bottles? Do you avoid drinking out of cane? To see the supplements discussed on various episodes of the Huberman Lab podcast, please go to livemomentous.com huberman we partner with Momentous because they are of extremely high quality, they ship internationally and they formulated supplements in the precise ways that are discussed that are not specifically non BPA containing cans and do you as optimal to take for various outcomes here on the Huberman Lab podcast? If you haven't already subscribed to the Huberman Lab podcast, actively avoid phthalates. My understanding is that phthalates are most in replacement enriched in pesticides and that's why you're seeing Dramatic Drops Newsletter. It is a monthly newsletter that includes summary of podcast episodes as well as toolkits, all of which are completely zero cost. All you have to do is provide your email to sign up. We do sperm and testosterone levels mainly in rural areas where they're dust cropping, not share your email with anybody. You do this by going to hubermanlab.com go to the menu and tap down to newsletter.

Yeah So I do avoid drinking out of cans that are plastics that may have BPA or bisphere.

Provide your email, you'll get a confirmation link. Click on that link and you'll receive our monthly newsletters. And you can also access any of the previous newsletters that we've released, including the Toolkit for Sleep, for Fitness, Deliberate Cold Exposure and so on by going to hubermanlab.com going to the menu, going to Enol A.

In them, Bisphenol A is known to bind to what I would consider the fifth estrogen receptor estrogen related receptor gamma newsletter.

And there you'll see those as immediately downloadable PDFs. Thank you once again for joining me for today's discussion about male Hormone Optimization with Dr. Kyle Gillette. And as always, thank you for your interest in science.

So it, it, I would, I would consider it a xenoestrogen. So phytoestrogens are estrogens from plants and in general they're not concerning or clinically significant. Xenoestrogens are just other estrogens. So I do avoid bpa. And I also test my water. I use a water testing service and I test it both after it's through my water filter and the tap water that my two boys drink almost every day. And it was very interesting. I only found one microplastic, just a bit over the reference range. So it wasn't a terrible tap score. But even in developed countries these are widely variable. As far as pathalates, again, very difficult and interesting to pronounce. But I remember learning about these because there was, I believe, a lawsuit that had to do with Mac and cheese. And this was probably five years ago. And I was coming up with my list of each provider that does obstetrics has a list what to avoid for the pregnant lady, you know, sketchy deli meats or high mercury fish like swordfish and salmon. And I actually added processed Mac and cheese to that list.

Interesting. Well, thank you for that. I'm going to extract your statement that you avoid drinking out of plastic bottles when, when possible. I'm guessing you're not neurotically attached to that. If you're dying of thirst, you might, you know, crack a plastic bottle of water to survive. But listen, Kyle, Dr. Gillette, thank you so much. You gave us an enormous wealth of knowledge, everything from behaviors to psychology to supplementation to prescription drugs. We will make sure to point out where people can get a hold of you on Instagram and on Twitter and on other websites in our show. Note captions. But really just on behalf of the audience. And just for myself, thank you so much. You have an immense amount of knowledge and you're exquisitely good at sharing it with people in an actionable way. So thank you.

My pleasure.

Thank you for joining me today for my discussion with Dr. Kyle Gillette all about Male Hormone Optimization. I just want to remind everybody that we will soon have an episode all about female Hormone optimization. If you're learning from and are enjoying this podcast, please subscribe to our YouTube channel. That's a terrific zero cost way to support us. In addition, please subscribe to the podcast on both Spotify and Apple. And on both Spotify and Apple you can leave us up to a five star review. If you have questions for us or comments about the podcast or guests that you'd like me to interview on the Huberman Lab podcast, please put those in the comments section on YouTube. We do read all the comments. In addition, please check out the sponsors mentioned at the beginning and throughout today's episode. That's the best way to support this podcast. If you're not already following Huberman Lab on social media, we are Huberman Lab on all platforms. So That's Instagram, Twitter, LinkedIn and Facebook. And all of those places. I describe science and science related tools, some of which overlap with the contents of the Huberman Lab podcast, but much of which is distinct from content on the Huberman Lab podcast. So again, it's Huberman Lab on all social media platforms. During today's episode and on many previous episodes of the Huberman Lab Podcast, we discussed supplements. While supplements aren't necessary for everybody, many people derive tremendous benefit from them for things like sleep hormone augmentation and focus. If you'd like to see the supplements discussed on various episodes of the Huberman Lab podcast, please go to livemomentous.com huberman we partner with Momentous because they are of extremely high quality, they ship internationally, and they formulated supplements in the precise ways that are discussed as optimal to take for various outcomes here on the Huberman Lab Podcast. If you haven't already subscribed to the Huberman Lab Podcast Newsletter, it is a monthly newsletter that includes summary of podcast episodes as well as toolkits, all of which are completely zero cost. All you have to do is provide your email to sign up. We do not share your email with anybody. You do this by going to hubermanlab.com, go to the menu and tab down to newsletter provide your email. You'll get a confirmation link. Click on that link and you'll receive our monthly newsletters and you can also access any of the previous newsletters that we've released, including the Toolkit for Sleep, for Fitness, Deliberate Cold Exposure, and so on, by going to hubermanlab.com, going to the menu, going to newsletter, and there you'll see those as immediately downloadable PDF. Thank you once again for joining me for today's discussion about male Hormone Optimization with Dr. Kyle Gillette. And as always, thank you for your interest in science.