Dr. Kyle Gillett: Tools for Hormone Optimization in Males

00:00:00.000 | - Welcome to the Huberman Lab Podcast,

00:00:02.260 | where we discuss science and science-based tools

00:00:04.900 | for everyday life.

00:00:05.900 | I'm Andrew Huberman,

00:00:10.200 | and I'm a professor of neurobiology and ophthalmology

00:00:13.140 | at Stanford School of Medicine.

00:00:14.980 | Today, my guest is Dr. Kyle Gillette.

00:00:17.380 | Dr. Kyle Gillette is a dual board certified physician

00:00:20.080 | in family medicine and obesity medicine,

00:00:22.500 | and an expert in hormone optimization.

00:00:25.180 | He is an MD, that is a medical doctor,

00:00:28.180 | and he treats patients with a variety of backgrounds,

00:00:31.020 | ages, and goals.

00:00:32.660 | Today, we discuss male hormone optimization.

00:00:35.640 | We discuss behavioral tools, nutrition-based tools,

00:00:39.240 | supplement-based tools, prescription drug-based tools,

00:00:42.740 | and their interactions in determining overall levels

00:00:46.240 | of testosterone, free testosterone, dihydrotestosterone,

00:00:50.620 | estrogen growth hormone, thyroid hormone,

00:00:52.680 | and many other hormones that impact mood, libido,

00:00:55.980 | well-being, strength, cognition,

00:00:59.060 | and various psychological factors.

00:01:01.340 | We covered hormone optimization in both men and women

00:01:04.060 | in previous episodes of the Huberman Lab Podcast,

00:01:06.880 | but today's discussion is different.

00:01:09.220 | Dr. Kyle Gillette offers very specific recommendations

00:01:12.040 | for people with different goals and of different ages,

00:01:15.820 | and we get deep into the weeds of, for instance,

00:01:18.940 | how does one know whether or not their testosterone

00:01:21.400 | is optimized or not?

00:01:23.040 | How often to test for specific hormones,

00:01:25.320 | such as testosterone and other hormones,

00:01:27.260 | and really how to gauge how good one should feel.

00:01:32.020 | This is something that's often overlooked in discussions

00:01:34.080 | about hormone optimization or health optimization

00:01:36.740 | of any kind, for that matter.

00:01:38.420 | For instance, people will talk about reduced libido

00:01:41.700 | and discuss whether or not testosterone levels are to blame,

00:01:45.180 | but how does one calibrate their libido in the first place?

00:01:47.760 | That is, how does one know whether or not their libido

00:01:50.020 | is normal, too low, or too high?

00:01:53.820 | We also discuss, for instance, whether or not

00:01:55.720 | hormone optimization should be pursued continually

00:01:58.260 | throughout the year, for instance, whether or not

00:02:00.060 | you should cycle on and off supplements

00:02:02.120 | and/or prescription drugs geared towards hormone optimization

00:02:05.720 | and we discuss the behavioral foundations

00:02:08.480 | of optimal hormone function.

00:02:10.160 | These are things that every male should be doing

00:02:12.440 | and various things they should actively avoid

00:02:15.020 | if their goal is to have healthy hormones

00:02:17.400 | and to quote unquote optimize their levels of every hormone

00:02:21.580 | from growth hormone to testosterone at any stage of life.

00:02:24.780 | And while today's discussion is about

00:02:26.220 | male hormone optimization, I want to emphasize

00:02:28.300 | that we discuss all the various ages

00:02:30.720 | for male hormone optimization.

00:02:32.700 | So for those of you that are parents,

00:02:34.700 | for those of you that are young,

00:02:36.420 | those of you that are middle-aged or old or teenagers,

00:02:39.720 | we explore adolescent, puberty, teen and late teens,

00:02:44.640 | early adulthood, adulthood and into the late geriatric ages.

00:02:49.040 | So regardless of your age and whether or not

00:02:50.460 | you are male or female,

00:02:52.060 | today's episode ought to be of interest to you.

00:02:54.500 | I should also point out that we will soon also

00:02:56.820 | be hosting an expert guest on female hormone optimization.

00:03:00.500 | One thing that I'm certain people of all ages

00:03:02.480 | and biological sex will enjoy about today's conversation

00:03:06.120 | is that we also get into descriptions of how psychology

00:03:09.100 | and life events impact hormones

00:03:11.180 | and how hormones impact our psychology

00:03:13.660 | and the way that we show up to various life events.

00:03:16.140 | So today is really a broad overview

00:03:18.460 | that goes all the way down to fine details

00:03:20.900 | about male hormone optimization.

00:03:22.660 | And I'm certain that by the end of today's episode,

00:03:25.060 | you'll have an immense amount of new information

00:03:27.540 | about how this endocrine, that is hormone system

00:03:30.280 | in your body works and how it interacts with your brain

00:03:34.080 | and other tissues and many, many actionable tools

00:03:37.500 | that you can pursue regardless of stage of life.

00:03:40.300 | Before we begin, I'd like to emphasize that this podcast

00:03:42.700 | is separate from my teaching and research roles at Stanford.

00:03:45.300 | It is however, part of my desire and effort

00:03:47.220 | to bring zero cost to consumer information

00:03:49.220 | about science and science related tools

00:03:51.360 | to the general public.

00:03:52.520 | In keeping with that theme,

00:03:53.620 | I'd like to thank the sponsors of today's podcast.

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00:07:40.740 | And now for my discussion with Dr. Kyle Gillette.

00:07:44.100 | Dr. Gillette, great to have you back.

00:07:46.440 | - Great to be back, thank you.

00:07:48.600 | - I'd like to begin with a question

00:07:50.060 | about one of the most mysterious

00:07:52.380 | and important phases of life, which is puberty.

00:07:56.460 | I've long wondered whether or not

00:07:59.940 | how quickly somebody goes into puberty, so at what age,

00:08:04.380 | and how long puberty takes.

00:08:06.400 | So how brief or protracted that puberty is

00:08:08.500 | for them to acquire

00:08:09.860 | the so-called secondary sexual characteristics,

00:08:11.940 | things like hair growth on the face for males,

00:08:14.600 | changes in bone and muscle density and growth, et cetera.

00:08:18.780 | When I was in middle school and high school,

00:08:21.960 | I noticed that some people transitioned

00:08:23.420 | into all that very fast,

00:08:24.620 | and some people took a long time

00:08:27.140 | to acquire those characteristics.

00:08:28.800 | Can we learn anything about ourselves, our hormones,

00:08:34.060 | and maybe even how long we're going to live

00:08:36.220 | based on the time in which we enter puberty,

00:08:39.400 | and how long it takes us to progress through puberty?

00:08:42.220 | I guess that also raises the question,

00:08:43.820 | does puberty ever truly end?

00:08:45.800 | - There are many takeaways from puberty.

00:08:49.060 | Some of the actionable items from it is,

00:08:52.120 | yes, it can and does affect your adult height,

00:08:56.400 | and also stature, and also body composition.

00:09:00.740 | So puberty is a time, and if we're talking specifically

00:09:05.660 | about males, think of it as a time

00:09:10.180 | where if you have obesity as a child,

00:09:13.140 | you could potentially use that time

00:09:16.020 | to change your lifestyle and habits and reset things,

00:09:18.580 | and it is a bit easier.

00:09:20.500 | It's almost like a free injection of testosterone

00:09:24.500 | and metabolism and drive and effort into your life.

00:09:28.020 | There is a wide variation in how quickly

00:09:31.620 | puberty goes through.

00:09:33.100 | So there's stages called tanner stages,

00:09:35.680 | which we don't necessarily need to get into,

00:09:37.740 | but if you enter puberty very early,

00:09:40.300 | then it can decrease your adult height or stature.

00:09:45.120 | - So for a given male that enters puberty at 13

00:09:49.060 | versus a male that enters puberty at 15,

00:09:52.320 | can we say that the guy that entered puberty at 13

00:09:55.740 | is going to be shorter than the guy that entered puberty

00:09:58.940 | at 15, or it's not quite that straightforward?

00:10:01.460 | - If they are identical twins and the individual

00:10:04.600 | who entered puberty at age 13 also finished puberty,

00:10:08.380 | went all the way through the tanner stages,

00:10:10.020 | and if you do a bone scan,

00:10:11.340 | which I believe is usually done on the left wrist,

00:10:14.060 | and it says, yes, your growth plates are mostly closed,

00:10:16.400 | you're not going to grow more than a couple inches

00:10:18.820 | of height after that.

00:10:20.260 | - Okay, just a related question.

00:10:23.960 | When I was growing up, it was thought,

00:10:26.400 | or at least people would say,

00:10:27.940 | that resistance training, in particular,

00:10:30.600 | lifting heavy weights could stunt one's growth.

00:10:33.660 | Is that true or false?

00:10:35.920 | - It is false when you're talking about

00:10:39.240 | just lifting heavy weights.

00:10:40.620 | Dirty bulking certainly has the potential

00:10:43.120 | to stunt one's growth for two main mechanisms.

00:10:45.740 | - Could you define dirty bulking?

00:10:47.760 | - So dirty bulking is eating an excess of calories,

00:10:51.700 | not just to acquire lean, metabolically active body mass,

00:10:56.700 | or get stronger, but purposely acquiring body fat.

00:11:01.280 | - So purposely acquiring muscle and fat by overeating

00:11:07.340 | and lifting weights can stunt one's growth.

00:11:10.660 | Do I have that correct?

00:11:11.780 | - Correct.

00:11:12.840 | So it does two things.

00:11:14.500 | If you're doing it as a very young child,

00:11:16.460 | it can, that fat can become leptin resistant

00:11:20.500 | and it can produce more leptin.

00:11:22.420 | And that leptin can activate the hypothalamus,

00:11:25.780 | which activates the pituitary,

00:11:27.860 | which releases gonadotropins,

00:11:29.220 | which basically just increase testosterone and estrogen

00:11:31.820 | earlier than it otherwise would have.

00:11:33.580 | It's the same mechanism behind why childhood obesity

00:11:37.180 | causes early puberty.

00:11:38.980 | - Interesting.

00:11:39.820 | I do remember a paper published in Science Magazine,

00:11:42.740 | I believe it was focused mainly on females,

00:11:44.940 | but showing that when enough body fat accumulates,

00:11:48.020 | the hormone leptin is secreted

00:11:49.380 | and that triggers the onset of puberty.

00:11:51.480 | - Correct.

00:11:52.320 | - Given the increase in childhood obesity

00:11:55.660 | that we're observing now,

00:11:57.260 | are we seeing an earlier onset of puberty

00:12:00.300 | in males and females?

00:12:01.860 | - Yes, in both males and females.

00:12:04.120 | Not to get too technical,

00:12:05.100 | but there's a G protein coupled receptor on the hypothalamus

00:12:08.140 | and leptin directly binds it.

00:12:09.940 | So it does appear directly causatory

00:12:12.820 | and not just correlation.

00:12:14.700 | - Okay, so, and if I understand correctly,

00:12:16.260 | what you're saying is for a young guy,

00:12:19.620 | let's say 13, 14, who wants to really bulk up

00:12:22.420 | and deliberately, excuse me, overeats

00:12:25.260 | and is doing their squats and deadlifts and bench presses

00:12:28.060 | and really trying to get big,

00:12:30.320 | they will get big, but only in the lateral dimension.

00:12:34.020 | They're effectively limiting their total height

00:12:38.100 | and it can shut down the long bone growth of their limbs.

00:12:41.520 | Is that correct?

00:12:42.520 | - Correct.

00:12:43.360 | The growth of the long bones is mostly related

00:12:45.740 | to the estradiol alpha receptor.

00:12:47.920 | So basically one of the receptors for estrogen,

00:12:50.540 | which can be secondary to early puberty

00:12:53.580 | and also is related to body fat

00:12:55.700 | because you have that conversion of testosterone to estrogen.

00:12:58.840 | - So can we assume that if a young male

00:13:04.340 | wants to get into resistance training,

00:13:06.860 | that body weight exercises are probably okay

00:13:10.180 | and maybe even some weight training, kettlebells, et cetera,

00:13:13.660 | but that they should avoid doing so-called dirty bulking,

00:13:16.740 | trying to deliberately gain weight up until what age?

00:13:20.500 | Until puberty is over?

00:13:21.900 | - I would say an individual should limit the amount

00:13:26.020 | of body, abnormal body fat accumulation

00:13:29.520 | or dirty bulking indefinitely throughout their entire life.

00:13:33.100 | - So again, if I understand correctly,

00:13:34.800 | that recommendation to avoid deliberate weight gain

00:13:38.200 | or rapid weight gain is not just to allow an individual

00:13:42.940 | to reach their maximum height,

00:13:44.900 | but also to avoid laying down

00:13:47.460 | a lot of body fat cells, correct?

00:13:50.000 | - Correct.

00:13:50.840 | The balance between that is

00:13:52.460 | when you are going through puberty,

00:13:54.260 | you are able to add a lot of lean body mass,

00:13:56.860 | not just muscle mass, but bone mass and other mass as well.

00:14:00.920 | - I started lifting weights when I was 16

00:14:02.860 | and I confess I trained pretty heavy at times.

00:14:07.100 | I don't know whether or not I would have been taller

00:14:09.360 | than I am now, but when I started that training,

00:14:12.620 | I had already reached what was at least close

00:14:15.800 | to my predicted height.

00:14:17.120 | I can't say that I deliberately waited until I had grown.

00:14:20.560 | It just so happened that I stumbled into the weight room

00:14:22.780 | and found that I liked it at age 16,

00:14:25.140 | at which point I was already the height that I am now.

00:14:28.300 | So in any case, what I'm hearing is that laying down

00:14:31.500 | a lot of excess body fat is not a good idea.

00:14:34.580 | What if somebody grows up chubby or fat for whatever reason,

00:14:39.580 | reasons related to the eating patterns in their family,

00:14:42.040 | maybe even some genetic reasons,

00:14:43.900 | is it safe and or wise for a young person,

00:14:48.080 | so let's say somebody who's around the age of puberty

00:14:51.080 | or even younger or in their late teens to be dieting

00:14:54.700 | and actively trying to lose body fat, is that safe?

00:14:57.440 | - Under the supervision of a physician,

00:15:00.160 | it is certainly safe to change your body composition.

00:15:03.200 | In pediatric obesity medicine,

00:15:05.520 | you're often talking about a recomposition

00:15:08.380 | or a renormalization of the growth curve

00:15:11.580 | compared to peers.

00:15:13.420 | - Great, thank you.

00:15:14.600 | So as you may have sensed,

00:15:16.040 | we started chronologically with puberty,

00:15:18.180 | and I know that there's another puberty

00:15:20.440 | that even precedes the puberty that we're all familiar with.

00:15:23.360 | Maybe if you want to just briefly mention that,

00:15:25.120 | 'cause I was talking with you about this before we started,

00:15:27.800 | the puberty that I'm most familiar with,

00:15:30.420 | and I think most people are most familiar with,

00:15:32.360 | the acquisition of deepening of the voice,

00:15:35.000 | growth of muscle and bone, body hair,

00:15:38.300 | acquisition of libido and things like that,

00:15:40.380 | that's actually the second puberty that we all go through.

00:15:43.120 | Maybe just mention for us and educate us

00:15:44.760 | on the first puberty.

00:15:45.880 | I think most people will be hearing this

00:15:49.280 | for the very first time.

00:15:50.880 | - The first puberty of everyone's life

00:15:53.080 | is the first three months of their life.

00:15:55.620 | You may notice that your baby has more acne

00:15:58.600 | the first three months,

00:15:59.600 | and that they also have in general,

00:16:02.900 | just more changes related to androgens and estrogens,

00:16:07.320 | perhaps oilier skin, even more genitourinary,

00:16:11.340 | like genital growth during the first three months.

00:16:14.460 | And this is mostly due to DHEA,

00:16:16.780 | which is an adrenal hormone.

00:16:18.720 | The second puberty or the puberty that most people know of

00:16:21.060 | actually starts that same way as well.

00:16:23.300 | It's called adrenarchy and it's when the adrenals kick in,

00:16:26.620 | I guess for the second time.

00:16:29.020 | - Is there a standard age or age range

00:16:31.420 | in which the testicles descend in males?

00:16:33.780 | - Usually before birth.

00:16:37.020 | It is not uncommon to have one

00:16:39.360 | or even two undescended testes,

00:16:41.720 | but there is a risk of testicular cancer,

00:16:43.560 | especially if they're not fixed early

00:16:45.880 | and also heat damage to the teste.

00:16:48.060 | - Well, thank you for that coverage of the two pubertys.

00:16:51.880 | So early in life,

00:16:52.760 | I imagine some of our listeners are probably

00:16:55.480 | still in one or the other puberty.

00:16:58.520 | The ones that are in the first puberty obviously

00:16:59.960 | aren't aware that they're listening to this podcast,

00:17:02.180 | but maybe it'll be embedded in their subconscious.

00:17:04.740 | But some listeners probably are still in puberty,

00:17:07.620 | but I think everyone can remember back to their puberty

00:17:09.560 | and roughly when they first entered puberty

00:17:11.480 | and how quickly they aggregated

00:17:13.040 | the secondary sex characteristics.

00:17:15.920 | I'd like to turn now to a general question

00:17:18.800 | about what all males ought to do

00:17:21.600 | in order to optimize their hormones.

00:17:24.180 | So if you could just list off the things

00:17:25.600 | that all males should do on a daily basis, weekly basis.

00:17:29.460 | I mean, should guys in their teens and twenties

00:17:31.700 | be getting their blood work done?

00:17:33.660 | Should they be taking supplements?

00:17:35.240 | We already talked about weight training.

00:17:36.760 | What should they be doing?

00:17:37.600 | What should they avoid doing

00:17:39.440 | if the goal is to have a long arc

00:17:41.600 | of healthy hormone optimization throughout the lifespan?

00:17:45.240 | - There's many things that you should do.

00:17:47.760 | An analogy that I often make is

00:17:50.040 | when there's a brand new car

00:17:51.360 | that comes off the assembly line,

00:17:52.960 | you do a full scope of diagnostic workup,

00:17:55.280 | hook it up to the computer.

00:17:56.840 | And I think we should do the same thing

00:17:58.020 | with humans as well.

00:17:59.500 | Dear in puberty, you know,

00:18:01.140 | obviously you're a functioning human,

00:18:03.180 | but I would say there's still development.

00:18:06.160 | And I think that the human always develops.

00:18:08.800 | I don't think development ever ends,

00:18:10.700 | but you want to monitor that progress

00:18:12.560 | across a person's lifespan.

00:18:15.520 | - Oh, sorry.

00:18:18.520 | So for blood work, I mean, what would be the earliest,

00:18:20.920 | let me put it this way.

00:18:23.440 | If blood work didn't cost anything

00:18:27.240 | and then everyone could get it,

00:18:28.480 | when would you want to see everybody

00:18:30.280 | get their blood work done for the first time?

00:18:33.260 | - Obviously individuals under the age of 18

00:18:36.260 | should talk with their parents about this.

00:18:38.300 | And as long as the parents and the child kind of agree

00:18:42.660 | and the parents are on board with this as well,

00:18:45.240 | you can start getting blood work.

00:18:47.300 | Often a child will come in with complaints

00:18:49.940 | of either precocious puberty or delayed puberty.

00:18:52.980 | And this individual might be nine

00:18:55.300 | or this individual might be 15.

00:18:57.580 | For a healthy child,

00:18:59.500 | when they're going through kind of their later tanner stages,

00:19:02.380 | which is four and five,

00:19:03.280 | so they've developed

00:19:04.120 | several secondary sexual characteristics.

00:19:05.740 | They might have hair growth

00:19:07.940 | or starting to notice more beard growth.

00:19:11.940 | That's a good time to do it.

00:19:14.040 | If you're concerned with stature or height,

00:19:16.740 | or if you're not tracking along

00:19:18.200 | where most members of your family have,

00:19:21.320 | not just their height and stature,

00:19:23.500 | but also the timing of their puberty,

00:19:25.820 | then that's time to get lapsed.

00:19:28.480 | - Great, so if I could travel back in time,

00:19:31.560 | I would have gotten my blood work done for hormones

00:19:33.820 | and lipids and everything else at 18.

00:19:36.400 | I unfortunately didn't know where and how to get that.

00:19:39.320 | And I didn't have any pressing clinical issues.

00:19:41.360 | And so I think the first time that I got my blood work done,

00:19:44.320 | I was in my late twenties, maybe even my early thirties.

00:19:47.860 | And I'm still dying to know what my blood work was

00:19:51.240 | when for instance, I was 17 and I felt a certain way.

00:19:54.540 | And I confess that in many dimensions,

00:19:57.760 | I actually feel better now at,

00:19:59.740 | I'll be 47 soon, at 47 than I did in my teens and twenties.

00:20:03.420 | And I think it was more on the psychological side.

00:20:06.140 | I think that, but in terms of just understanding

00:20:10.300 | why we felt great or why we felt or feel terrible

00:20:14.740 | or not so great, I think blood work is extremely informative.

00:20:17.900 | What do you think are the key things

00:20:19.720 | to look for in blood work?

00:20:21.100 | I mean, testosterone is always the topic that comes up

00:20:23.700 | in the context of male hormone optimization,

00:20:25.580 | but certainly there are a lot of other hormones

00:20:26.960 | that are important as well.

00:20:28.740 | And with testosterone, you want to get either testosterone

00:20:31.420 | and an SHBG or a free testosterone.

00:20:34.140 | Could you define SHBG for our listeners, please?

00:20:36.380 | It is sex hormone binding globulin.

00:20:38.380 | It is the protein that binds up all androgens

00:20:41.680 | and estrogen in the body.

00:20:43.300 | So the stronger the androgen, the stronger it binds.

00:20:46.520 | During puberty, strong androgens, especially DHT,

00:20:50.500 | which is the strongest bio-identical androgen,

00:20:53.580 | has a huge role, a prominent role

00:20:56.660 | in secondary sexual characteristics.

00:20:59.300 | And if your SHBG is very high,

00:21:01.580 | then your DHT can run higher because it's not metabolized,

00:21:05.260 | but there's not quite as much free DHT.

00:21:07.460 | So you want to balance between a high enough free DHT

00:21:12.300 | and a high enough total DHT.

00:21:14.300 | - And obviously these blood tests are going to have

00:21:16.100 | to be read and interpreted by a qualified physician.

00:21:19.100 | Most people aren't going to be in a position

00:21:20.640 | to evaluate them properly,

00:21:22.500 | or at least not with the full depth that they could

00:21:24.260 | if they had an MD like yourself looking at them.

00:21:27.340 | Okay, so everyone should get blood work as early as possible,

00:21:31.100 | depending on their budget and availability.

00:21:34.060 | What should everybody do

00:21:36.380 | in terms of monitoring those markers?

00:21:39.020 | So assuming that there's no major intervention,

00:21:41.680 | how often do you recommend

00:21:42.780 | that people get their blood work done?

00:21:44.840 | - Let's say, let's take an individual who just turned 18.

00:21:49.020 | They just got their first set of blood work.

00:21:50.740 | They'll probably find something in it

00:21:52.120 | that they may want to optimize using shared decision-making

00:21:55.460 | with their physician.

00:21:57.180 | Usually a good follow-up is about six months.

00:21:59.860 | - Okay, so twice a year getting blood work done

00:22:02.860 | and having a physician evaluate it.

00:22:04.760 | That sounds reasonable to me.

00:22:05.820 | And for those that didn't initiate this at 18,

00:22:08.620 | such as myself, it's the best time to start then

00:22:11.300 | would be as soon as possible.

00:22:12.880 | - Yeah. - Right?

00:22:13.780 | In terms of the other things that all males should do,

00:22:18.060 | meaning all males of all ages, puberty and beyond,

00:22:21.900 | should do, what are some of those things?

00:22:25.000 | So on a daily basis,

00:22:26.460 | maybe you could just take us through the arc of a day

00:22:29.040 | and push out some of the protocols that you use

00:22:32.380 | or the things that you'd like to see your male patients use

00:22:34.560 | in order to try and optimize their hormone status.

00:22:37.960 | - I'll briefly touch on some of the lifestyle pillars

00:22:40.140 | to start diet and exercise are the first two.

00:22:43.580 | In puberty, sleep is particularly important, of course.

00:22:46.580 | But with diet and exercise,

00:22:50.320 | throughout a lifespan,

00:22:52.920 | you want to not exclude things that are helping you.

00:22:56.840 | For example, during puberty, if you're consuming dairy

00:22:59.900 | and then all of a sudden you cut out all dairy,

00:23:01.880 | dairy can help increase IGF-1 and free IGF-1.

00:23:05.120 | - And just for our audience,

00:23:07.080 | maybe you just mentioned what having enough IGF-1

00:23:10.100 | can do for us that's beneficial is?

00:23:12.200 | - It helps you grow.

00:23:13.200 | It helps with genital development,

00:23:15.960 | secondary sexual characteristics, and long bone growth,

00:23:20.440 | skin growth, hair growth, a host of things.

00:23:22.840 | - So getting an array of nutrients that include dairy,

00:23:26.480 | what other sorts of nutrients are important

00:23:28.200 | during development?

00:23:29.240 | - You want to have adequate vitamin D.

00:23:32.320 | Vitamin D helps with testosterone production.

00:23:34.440 | It helps, again, with bone mineralization and stature.

00:23:39.440 | After an age of about 25, and there's not a strict cutoff,

00:23:44.120 | but up to about an age of 25,

00:23:45.960 | optimizing your growth hormone and IGF-1

00:23:48.140 | helps with bone density and bone growth.

00:23:51.880 | So from the dietary standpoint,

00:23:54.060 | you want to have enough free estrogen,

00:23:56.320 | not too much when you're growing,

00:23:58.000 | but you want to help basically stockpile bone

00:24:02.580 | to prevent a risk of osteoporosis or thin bones fractures

00:24:06.640 | when you're older.

00:24:07.640 | - Well, as someone who broke his left foot five times

00:24:10.880 | while in high school,

00:24:12.060 | I can say whatever young people can do

00:24:14.360 | to optimize their bone density would be great.

00:24:16.900 | That problem seems to have resolved itself over time,

00:24:19.080 | but I don't know, back then I was,

00:24:21.280 | I did a short run as a vegetarian,

00:24:22.760 | but I've always been an omnivore.

00:24:25.160 | I realize that some of this relates to ethics

00:24:27.440 | and food allergies and things of that sort,

00:24:29.160 | but would you say that on balance,

00:24:31.780 | that most people would benefit from eating a combination

00:24:36.080 | of quality proteins from animal sources

00:24:39.360 | and non-animal sources, fruits, vegetables,

00:24:41.680 | and starches?

00:24:42.920 | I mean, what do you think, for instance,

00:24:44.220 | about people following a pure carnivore

00:24:46.500 | or a very pure vegan diet in their 20s and 30s?

00:24:50.500 | - In their late 20s, it might be a reasonable option.

00:24:54.720 | In early 20s and certainly teens,

00:24:56.920 | it is a horrible idea because it is likely

00:24:59.340 | to significantly decrease your free androgens.

00:25:02.080 | So you will have less testosterone acting on receptors

00:25:04.760 | through the body.

00:25:05.600 | - Are there any other micronutrients or macronutrients

00:25:10.080 | that people in their 20s and 30s should emphasize?

00:25:12.720 | - We haven't really touched on fatty acids

00:25:15.800 | or fiber too much.

00:25:17.400 | Fiber is going to be paramount in kind of like

00:25:20.360 | setting your set point of your gut microbiome

00:25:22.920 | the rest of your life.

00:25:24.400 | There is prebiotic fiber, which you could think of

00:25:27.240 | as fish food for your good gut microbiome.

00:25:30.200 | Your gut microbiome is kind of like an aquarium

00:25:32.480 | or a fish tank.

00:25:33.300 | - No, I'm just thinking about goldfish swimming around

00:25:35.280 | and the goldfish eating people don't eat goldfish people.

00:25:39.040 | - Yup.

00:25:39.880 | - Live or dead.

00:25:41.080 | - Yeah, but any fiber or food that you're putting

00:25:44.320 | in your gut, it's either going to,

00:25:46.360 | it's going to skew your gut microbiome

00:25:48.440 | towards something that is more beneficial

00:25:50.680 | or more detrimental.

00:25:52.480 | - And would you say that the prebiotic fiber

00:25:55.440 | and getting essential fatty acids,

00:25:57.760 | that would be important to do throughout the lifespan

00:26:00.280 | or just for people in their 20s and 30s?

00:26:02.320 | - Throughout the lifespan, particularly important

00:26:05.140 | in the teenage, 20s, 30s,

00:26:07.360 | because it helps with brain development.

00:26:09.920 | You're certainly more of an expert than me

00:26:12.000 | when it comes to brain development,

00:26:14.720 | but it does continue to develop

00:26:17.120 | really throughout the lifespan,

00:26:18.340 | but certainly through the 20s and 30s as well.

00:26:20.760 | - About taking a multivitamin while you're growing up,

00:26:23.420 | so many people do that.

00:26:25.720 | Is it necessary?

00:26:26.680 | Is it useful?

00:26:27.520 | And if it's not necessary, is it safe to do anyway?

00:26:30.480 | - It's generally safe to do anyway.

00:26:33.840 | I do not think everybody needs a multivitamin.

00:26:38.000 | The more exclusionary your diet is,

00:26:40.760 | for example, if you have celiac disease

00:26:43.640 | or if you're planning on fertility soon,

00:26:45.820 | then perhaps it's more reasonable to take a multivitamin.

00:26:48.480 | - In a previous discussion of ours,

00:26:49.840 | I asked you about caloric restriction and testosterone.

00:26:53.240 | And if I recall correctly,

00:26:54.840 | the idea was that if somebody is overweight,

00:26:57.140 | they have excess fat, adipose tissue,

00:26:59.440 | then getting rid of some of that adipose tissue

00:27:02.280 | through caloric restriction and exercise,

00:27:04.120 | provided it's done not too fast in a healthy way,

00:27:06.820 | is going to be beneficial for testosterone in the long run.

00:27:10.160 | But that for individuals who are not carrying

00:27:13.100 | an excess of body fat,

00:27:14.240 | caloric restriction is actually going to lower testosterone.

00:27:17.400 | First of all, do I have that correct?

00:27:20.320 | And second, are there any addendums to that

00:27:23.620 | that you'd like to give us now?

00:27:25.300 | - That's correct.

00:27:27.880 | If you look at an individual in a caloric deficit,

00:27:31.880 | several changes will happen.

00:27:33.440 | One is that they'll have less building blocks for hormones.

00:27:37.640 | Another is that they will be in a catabolic state more often

00:27:40.920 | so that balance of anabolism and catabolism

00:27:43.600 | will be different.

00:27:44.760 | They'll likely have less signaling

00:27:46.340 | from growth hormone and IGF-1.

00:27:49.080 | And they'll also have the high SHBG

00:27:51.580 | that we defined earlier as the binding protein.

00:27:53.760 | So there are free androgens

00:27:55.580 | and free estrogens will go down.

00:27:57.840 | - Got it.

00:27:58.680 | Okay, so we touched on sleep being critical,

00:28:01.360 | I would say, throughout the lifespan,

00:28:02.720 | trying to get enough quality sleep

00:28:05.360 | at least 80% of the nights of your life.

00:28:07.120 | And the other 20% are just what happens

00:28:09.880 | when there's noise outside or you're stressed.

00:28:12.320 | It just, you have an exam

00:28:13.640 | or you're having a great time for whatever reason.

00:28:16.080 | There are a lot of good reasons

00:28:17.440 | to lose some sleep now and again as well.

00:28:19.560 | But so we have sleep, we've got nutrition,

00:28:23.020 | and we touched on that.

00:28:24.200 | We'll get back into supplementation.

00:28:26.480 | What are some of the other pillars

00:28:28.080 | of creating the proper environment for hormone optimization?

00:28:31.540 | - Stress is probably the next one.

00:28:34.920 | During both puberty, but also the 20s and 30s,

00:28:40.760 | individuals are figuring out

00:28:43.320 | how they want to cope with stress

00:28:44.960 | and also figuring out what they want to choose

00:28:47.360 | to put their effort into.

00:28:48.980 | So if someone is overstressed,

00:28:51.720 | then they can have,

00:28:52.880 | it can put all the other lifestyle pillars

00:28:55.880 | and then they stop dieting well,

00:28:58.360 | they stop exercising and everything else can go askew.

00:29:01.880 | There is also some degree of a social component to this.

00:29:07.780 | So perhaps I need to add a seventh pillar of social.

00:29:10.440 | During your 20s and 30s,

00:29:13.280 | you may be forming a family as well.

00:29:15.600 | Perhaps you have children

00:29:16.920 | and the health of the family unit

00:29:19.960 | is going to be vitally important.

00:29:22.000 | Not necessarily directly for hormone optimization,

00:29:26.840 | but it's going to throw everything else off if it's off.

00:29:29.160 | - And for people that are not starting their own families

00:29:32.440 | in their 20s and 30s,

00:29:33.360 | can that social connection be extended to friendships

00:29:36.360 | and work relationships as well?

00:29:38.300 | - Absolutely.

00:29:39.140 | In fact, if someone's not starting a family,

00:29:41.000 | it is just as concerning, but for other reasons.

00:29:44.840 | Each individual is going to have

00:29:45.920 | their close group of family and friends.

00:29:47.920 | And if someone does not have one of those connections,

00:29:50.940 | that's when things can potentially get bad,

00:29:54.360 | not just for them individually, but also society.

00:29:57.160 | - So when you say stress,

00:29:58.240 | you mean learn to manage your stress.

00:30:00.520 | What does that look like?

00:30:01.640 | I mean, if a patient has high blood pressure,

00:30:04.580 | even if they don't, you just sense that they're stressed.

00:30:07.440 | They have a lot of pressured speech

00:30:08.720 | or they're not feeling well

00:30:09.800 | or communicating that they're not doing well.

00:30:11.940 | What are some of the things that you recommend

00:30:13.640 | in order to try and ameliorate that stress?

00:30:15.960 | - There's different mindfulness or relaxation techniques.

00:30:19.440 | Going outside can often help with this as well.

00:30:22.360 | Dietary changes and exercise can help with this too.

00:30:26.480 | Some people like prayer or meditation,

00:30:29.080 | and a lot of people like counseling or therapy,

00:30:32.680 | or even just talking openly with a family member or a friend.

00:30:36.160 | - What would be some of the other pillars

00:30:39.220 | for hormone optimization?

00:30:40.400 | Here, I feel like we're not just talking about people

00:30:41.860 | in their 20s and 30s, but again,

00:30:43.100 | we're wrapping our arms around basically puberty onward.

00:30:47.240 | I mean, gosh, looking back,

00:30:49.040 | I started meditating pretty early.

00:30:50.560 | I started weight training and running early.

00:30:52.260 | I gave some thought to my diet in high school,

00:30:54.960 | but really it was in college that I started thinking more

00:30:57.520 | about what I was ingesting and why,

00:30:59.280 | and trying to do better there.

00:31:00.900 | But people are coming to the table at different stages

00:31:03.640 | of life and trying to optimize for hormones.

00:31:07.000 | So what would be some of the additional things

00:31:09.460 | that everybody should do?

00:31:10.720 | - Everyone should get outside

00:31:13.380 | and find a movement past time to last a lifetime.

00:31:18.420 | You're gonna get sunlight,

00:31:19.380 | you're gonna get some degree of heat and cold exposure,

00:31:22.300 | and you're also just gonna move more.

00:31:24.480 | Being in an artificial environment

00:31:26.740 | where there's artificial lights,

00:31:28.040 | artificial air conditioning is going to have many effects

00:31:33.040 | on your body, so that's vital.

00:31:36.700 | Another one is finding what your purpose is in life.

00:31:40.400 | So I call this spirit,

00:31:41.880 | but it's really just the self-actualization component

00:31:44.540 | of Maslow's hierarchy of needs,

00:31:46.700 | which is basically your physical needs,

00:31:48.000 | your mental needs, and then your purpose in life,

00:31:49.940 | what you really like to do.

00:31:52.080 | - Picking some goal or target.

00:31:53.580 | And I always say that you don't have to stick

00:31:55.260 | to the same goal over time.

00:31:56.300 | Certainly I haven't,

00:31:57.200 | although I got started early in the science game

00:31:59.080 | and I'm still in it.

00:32:00.860 | The idea is not to pick the end goal,

00:32:03.580 | it's to pick a goal.

00:32:05.140 | And then once you reach that goal to assess

00:32:08.340 | and then pick another goal and so on.

00:32:10.100 | I think sometimes when people hear about picking a purpose,

00:32:12.060 | they're like, oh my goodness, I have to define,

00:32:13.420 | sort of like naming oneself,

00:32:15.180 | that you actually can change your goals

00:32:18.600 | and purpose over time.

00:32:20.220 | This is terrific.

00:32:21.060 | Would you suggest that people actively use

00:32:25.240 | or avoid supplementation

00:32:27.120 | prior to doing all these other things?

00:32:30.080 | I'm somebody that likes to throw the kitchen sink at things,

00:32:32.200 | but I also like to do things pretty systematically.

00:32:33.960 | So I always say behaviors first, then nutrition,

00:32:36.580 | then supplementation, and then maybe,

00:32:39.020 | and if and only if there's a real need,

00:32:41.240 | and of course, working with a doctor, prescription drugs.

00:32:43.860 | But there are probably people in their 20s or 30s,

00:32:46.740 | maybe even in their 50s that aren't feeling great

00:32:49.320 | and they want to do something in order to be able

00:32:50.980 | to train more and, or to feel more confident

00:32:54.720 | to seek out social connection.

00:32:55.960 | They try and go about the whole business

00:32:58.980 | from the other side as well.

00:33:01.220 | What are your thoughts on that?

00:33:03.340 | - I see supplements and medications as very similar,

00:33:06.180 | one's prescribed and one's not.

00:33:08.100 | In general, medications have more side effects

00:33:10.740 | or potentially stronger therapeutic with more efficacy,

00:33:14.860 | but they're just tools to reach an end goal.

00:33:17.860 | So depending on the goal,

00:33:19.220 | if there's an individual that's an athlete,

00:33:21.300 | then certainly they should consider supplementation.

00:33:24.220 | Or if someone desires optimal

00:33:27.660 | or a very high level of cognitive performance,

00:33:30.540 | they should also consider supplementation.

00:33:32.600 | At the same time, food is medicine

00:33:34.300 | and a lot of the benefits you can get in supplements,

00:33:36.400 | you can get in food as well.

00:33:37.820 | - Yes, it depends on how much time and energy

00:33:39.840 | you're willing to spend.

00:33:40.680 | Also finances, you know, I know that when I was in college,

00:33:43.160 | I could afford just a few supplements

00:33:45.400 | and they were basically whey protein and some fish oil.

00:33:49.160 | I was fortunate that I was pointed in the direction

00:33:50.780 | of those things and some creatine.

00:33:52.180 | I couldn't afford much else.

00:33:54.100 | Over time, of course, I could afford more,

00:33:55.700 | but it really does often depend on finances.

00:33:59.040 | Before we get into some specific recommendations

00:34:03.040 | to optimize testosterone, estrogen,

00:34:05.480 | thyroid, growth hormone, et cetera,

00:34:07.580 | I want to ask you a question

00:34:08.420 | I've been wondering about for a long time.

00:34:10.160 | You know, so often in the discussion

00:34:11.680 | about male hormone optimization,

00:34:13.360 | people will say, well, you know,

00:34:16.080 | if your libido is suffering, you know,

00:34:18.640 | you might want to be concerned about testosterone

00:34:21.240 | or even estrogen, right?

00:34:22.260 | 'Cause we know that estrogen can impact libido as well.

00:34:24.680 | Sometimes having estrogen too low is detrimental for libido.

00:34:28.320 | Or people will say, you're not recovering from workouts

00:34:30.940 | or you're just, or you're feeling kind of depressed.

00:34:32.640 | The problem is it's all subjective.

00:34:34.720 | So how does one know whether or not

00:34:37.760 | their recovery from workouts, their energy,

00:34:41.040 | their confidence, their libido is within a healthy range?

00:34:44.640 | I mean, obviously for people in a relationship,

00:34:46.200 | they can know whether or not their libido matches

00:34:48.240 | the sort of cadence of the relationship and their partner.

00:34:51.800 | But how should people think about this?

00:34:54.780 | And maybe you can start to talk about it

00:34:56.160 | because one of the big differences, I think,

00:34:57.640 | between males and females

00:35:00.120 | is that because females have a monthly cycle,

00:35:02.920 | they are familiar with the changes that occur

00:35:05.880 | in their hormones over time.

00:35:07.260 | Because every 28 days,

00:35:08.360 | those hormones are changing dramatically

00:35:10.000 | in ways that impact their physiology and psychology.

00:35:12.520 | But for males, I feel like there's sort of a dearth

00:35:15.720 | of language to get into the more subtle aspects of this.

00:35:19.640 | It also has to do with privacy issues

00:35:21.160 | and people feeling like they don't want to overshare

00:35:24.100 | too much, not knowing what's appropriate to share.

00:35:26.880 | But when you talk to a patient who's in their 30s

00:35:29.360 | or maybe even their 70s or 60s, doesn't matter,

00:35:31.660 | a male patient, what are you listening for?

00:35:34.680 | And I know you're not a psychiatrist,

00:35:37.600 | but what are your ears tuned to

00:35:39.560 | in order to try and figure out whether or not

00:35:40.960 | this person could really use some help

00:35:42.420 | with hormone optimization or whether or not something else,

00:35:45.000 | or maybe they're just doing great and they don't realize it

00:35:46.980 | because they're placing demands on themselves

00:35:48.620 | that are excessive?

00:35:49.580 | - You want to use a lot of open-ended questions.

00:35:53.140 | This process is called motivational interviewing.

00:35:56.180 | And your goal is to listen to the patient

00:35:59.180 | and not plant an idea in their mind that they can follow.

00:36:03.960 | Because everybody is going to have a different goal.

00:36:06.920 | Some people are better at reading their biofeedback

00:36:09.820 | or telling how they feel on a daily basis.

00:36:13.600 | There is screening questionnaires designed, for example,

00:36:17.200 | an ADAM questionnaire to look at men's health

00:36:20.780 | and hormone-related health.

00:36:22.700 | - It's called an ADAM questionnaire?

00:36:24.160 | - ADAM questionnaire. - A-D-A-M?

00:36:25.700 | - Correct. - Is it available online

00:36:27.140 | that people could administer it to themselves?

00:36:28.920 | Although we don't want people making clinical diagnoses

00:36:30.960 | of themselves or anyone else, is it that sort of exam?

00:36:33.680 | - It is. - Interesting.

00:36:35.020 | - I don't believe it is a clinically validated tool

00:36:37.540 | like an ASCVD, which is like a risk of heart attack

00:36:40.340 | and stroke tool or many other tools.

00:36:43.820 | There's one for depression, there's one for anxiety.

00:36:45.860 | They're called PHQ-9 and GAD-7 respectively.

00:36:49.640 | But anyway, there's often an in the ADAM questionnaire

00:36:54.640 | and what you hear from the patient,

00:36:56.300 | if you are a very careful listener, is often different.

00:37:01.120 | - Can you give me an example of some of the questions

00:37:02.720 | on this ADAM questionnaire

00:37:03.960 | or the sorts of motivational interviewing that you might do?

00:37:06.920 | So let's say I'm your patient, we sit down,

00:37:09.200 | what sorts of questions would you ask

00:37:10.480 | to probe these kinds of dimensions of hormones?

00:37:13.560 | - Questions about libido,

00:37:15.180 | questions about athletic performance,

00:37:17.320 | questions about motivation.

00:37:19.480 | And often the patient will answer one thing,

00:37:22.040 | but what you hear from them subjectively is far different.

00:37:26.440 | - Interesting.

00:37:27.280 | Can you give me an example of a question?

00:37:29.240 | I'm happy to be the guinea pig here.

00:37:31.620 | A classic one is a guy comes in and a lot of times they say,

00:37:36.620 | "Oh, no, the wife made me go to the doctor."

00:37:39.000 | I go, "Once a year, that's it, I don't want anything.

00:37:41.680 | "I don't want any medications."

00:37:43.680 | Their screening questionnaires might be zeros

00:37:46.500 | across the board, so nothing, no issues.

00:37:48.680 | They're apparently in perfect health.

00:37:50.780 | They talk to you for a while, they get some rapport,

00:37:53.640 | they like you and then right as you're finishing up the visit

00:37:56.680 | and about to go out the room,

00:37:58.540 | they mentioned that their libido isn't quite there

00:38:01.880 | and they're having a little bit of ED as well

00:38:04.000 | and perhaps are even having some chest pressure tightness.

00:38:07.240 | - I see.

00:38:08.080 | So right as you're leaving the room,

00:38:09.760 | a patient will tell you

00:38:10.640 | that they're having some sexual side effects

00:38:12.880 | or not side effects,

00:38:13.720 | they're having some sexual challenges

00:38:15.520 | and then they'll mention chest pressure.

00:38:17.960 | Is the chest pressure a sort of general decoy

00:38:20.200 | for it's got to be my heart

00:38:21.680 | or is it related to the other things they're reporting?

00:38:25.080 | - It can be related.

00:38:26.240 | In fact, erectile dysfunction is known as the canary

00:38:29.780 | in the coal mine.

00:38:31.100 | So coal miners would take the canary down

00:38:33.000 | and the canary would die before the coal miners would have,

00:38:36.040 | I believe, carbon monoxide poisoning.

00:38:38.520 | And often one of the causes of ED is plaque buildup,

00:38:42.720 | which can happen in the coronaries as well,

00:38:44.900 | but sometimes they notice the symptom in the genitals

00:38:48.160 | before they do in the coronaries.

00:38:49.880 | - So for such a patient,

00:38:51.800 | let's say that patient was a young person

00:38:53.760 | where plaque buildup in the arteries and veins

00:38:56.740 | is not all that likely if they're,

00:38:58.600 | let's say in their 20s or 30s,

00:39:00.720 | what would be your next step of the interview at that point

00:39:03.280 | and what would you consider?

00:39:04.400 | Would you immediately order labs for that person

00:39:06.480 | to try and rule out any kind of

00:39:08.040 | actual hormone level deficiency?

00:39:11.480 | - I certainly would order labs.

00:39:13.680 | There are some individuals that are very similar

00:39:15.840 | and they come in and they have the same symptoms

00:39:17.880 | and one individual might have a very, very high testosterone

00:39:21.400 | and one individual might be severely hypogonadal.

00:39:24.960 | So there's a big difference between the subjective

00:39:27.760 | and what the labs look like.

00:39:29.260 | So I certainly order labs.

00:39:31.320 | You also ask them about if it's situational or not.

00:39:35.560 | You ask them if they have ED,

00:39:36.800 | if they're, you know, you ask them about their habits.

00:39:39.380 | You even ask about porn and masturbation

00:39:41.980 | and all these issues.

00:39:42.960 | And of course it's between the doctor and the patient.

00:39:45.480 | And depending on what they tell you,

00:39:47.040 | you can often determine if there is a situational component.

00:39:51.240 | Some people call it it's psychogenic ED,

00:39:53.720 | but I don't love the term psychogenic ED

00:39:56.100 | because it kind of puts some blame on the patient's mind.

00:40:01.100 | But a lot of the time that is the case.

00:40:03.280 | There's even a test and this is very rarely ordered,

00:40:06.920 | but it's called a nocturnal penile tumescence.

00:40:10.000 | - Yeah, because is it true that there are

00:40:13.200 | periodic erections during sleep, correct?

00:40:15.440 | - Yes. - Yeah.

00:40:16.280 | - So you basically put a cuff to see

00:40:18.920 | if you were having a normal sized erection during sleep.

00:40:23.040 | And I believe about 90% of the time they do that test,

00:40:26.600 | they are indeed having erections.

00:40:28.480 | - Which would point to this psychogenic origin

00:40:31.320 | of whatever challenges they're having

00:40:33.480 | in terms of sexual interactions.

00:40:34.880 | You mentioned porn and masturbation.

00:40:37.660 | This topic has come up a bunch of times on this podcast

00:40:40.560 | and on other podcasts I've gone on

00:40:41.920 | because of the relationship between dopamine,

00:40:44.600 | sexual motivation and sexual behavior.

00:40:47.920 | And I've been of the pretty strong stance

00:40:51.400 | that while I'm not judging porn or masturbation,

00:40:54.680 | it can create a brain wiring situation

00:40:57.800 | where males in particular essentially teach their brain

00:41:01.860 | to be aroused by watching other people have sex

00:41:04.540 | as opposed to being the first person actor

00:41:06.380 | in sexual interactions.

00:41:09.440 | So in that sense, that's more about the brain wiring

00:41:13.000 | and neuroplasticity and dopamine,

00:41:14.680 | but what are your thoughts on porn and masturbation

00:41:17.120 | as they relate to hormones?

00:41:18.280 | I mean, this is a big debate on the internet.

00:41:20.080 | In fact, one of the most common debates

00:41:22.340 | is whether or not masturbation increases

00:41:24.940 | or decreases testosterone in males.

00:41:27.240 | Certainly it will decrease motivation

00:41:29.920 | to go find sexual partners.

00:41:31.920 | We know this and there are more and more data

00:41:34.880 | on this all the time.

00:41:36.360 | In terms of the effects of pornography and masturbation,

00:41:39.680 | and here I suppose we need to be somewhat specific

00:41:42.560 | and operationally define what we're talking about.

00:41:44.220 | We're talking about porn and masturbation

00:41:46.640 | to the point of ejaculation, right?

00:41:48.740 | Because my understanding is that the ejaculation

00:41:54.000 | and orgasm associated with it

00:41:55.760 | cause an increase in prolactin,

00:41:57.080 | which blunts libido for some period of time.

00:41:59.560 | The duration of that will vary from person to person

00:42:01.880 | and circumstance to circumstance.

00:42:03.620 | But basically all of this points to the fact

00:42:05.800 | that porn and masturbation can really limit libido

00:42:10.000 | in the real world.

00:42:11.840 | And to me, pornography and the screen is not the real world.

00:42:15.800 | The screens exist in the real world,

00:42:17.520 | the real world doesn't exist in the screen.

00:42:20.200 | - That's an accurate statement.

00:42:21.520 | And prolactin does have a significant acute increase

00:42:26.520 | after ejaculation.

00:42:29.440 | It does to some degree after orgasm as well,

00:42:33.120 | but prolactin acts on the pituitary

00:42:35.800 | to inhibit the release of the hormones LH and FSH,

00:42:39.720 | of which LH can increase testosterone.

00:42:42.800 | So this may be one of the cases

00:42:44.780 | where the dose makes the poison.

00:42:46.440 | And if it is a very frequent habit,

00:42:48.200 | certainly daily or more than once a day

00:42:52.240 | would be very detrimental from a hormonal component,

00:42:55.800 | not even taking into account the neural wiring.

00:42:59.840 | - Listen, I think it's terrific

00:43:00.840 | that you've actually defined frequency

00:43:02.320 | because this is the problem on the internet

00:43:03.920 | or even in the doctor's office,

00:43:05.520 | you'll see descriptions about pornography

00:43:07.920 | being dangerous for certain things

00:43:09.800 | or detrimental to hormones.

00:43:11.240 | People say frequent, but what's frequent?

00:43:12.800 | So you were saying daily or multiple times per day

00:43:15.000 | would be potentially detrimental to the hormone profile

00:43:18.740 | of a male of essentially any age.

00:43:20.660 | - And that's just for masturbation.

00:43:22.440 | With pornography, with porn use as well,

00:43:27.980 | it would likely be worse.

00:43:30.240 | - Why is that?

00:43:31.280 | Just the sort of dopaminergic drive of the stimulus,

00:43:34.500 | just the really intense visual stimulus?

00:43:37.100 | - Dopamine sensitivity.

00:43:39.100 | I think that using the analogy of a dopamine wave pool,

00:43:43.140 | it would deepen the pool,

00:43:44.700 | but not increase your supply of dopamine.

00:43:47.660 | - Maybe you could describe the dopamine wave pool

00:43:49.260 | 'cause I think it's such a powerful way

00:43:50.980 | of thinking about dopamine and what dopamine does.

00:43:53.060 | In fact, I've always credited you when I've done it,

00:43:56.600 | but I've generally stolen your analogy

00:43:59.600 | of the dopamine wave pool because it's so astute.

00:44:03.340 | - The dopamine wave pool describes the natural variation

00:44:06.900 | of ups and downs in your dopamine or your motivation.

00:44:10.380 | And in the wave pool, depending on how high the peak is,

00:44:15.380 | you often have a deeper trough.

00:44:20.220 | So you do not want too high of a peak.

00:44:22.400 | In addition, if your peak is very, very high,

00:44:25.660 | for example, when you're using many substances

00:44:30.100 | like cocaine or like amphetamines,

00:44:32.580 | your dopamine can go so high,

00:44:34.440 | you lose almost all the water from the wave pool.

00:44:37.140 | And then when you crash from that,

00:44:38.340 | not only is the trough low,

00:44:40.060 | you have less dopamine in the pool to begin with.

00:44:43.500 | The dopamine receptor is extremely sensitive

00:44:45.960 | as is the GABA receptor, which is an inhibitory receptor.

00:44:48.880 | Whereas dopamine is technically a stimulant

00:44:51.000 | more related to adrenaline and noradrenaline.

00:44:54.080 | The depth of the pool can change very quick.

00:44:58.040 | So you wanna have that happy medium

00:44:59.600 | where you're fairly near the top,

00:45:01.480 | but you're not so near the top

00:45:03.280 | that the depth of the pool is going to go down.

00:45:06.060 | - So if I interpret that in the context of this discussion

00:45:10.520 | about libido sex, porn and masturbation,

00:45:14.860 | if somebody has a very intense sexual experience,

00:45:18.180 | and here we're not necessarily

00:45:19.520 | talking about an intense orgasm,

00:45:21.900 | we're talking about just a lot of intense visual,

00:45:24.740 | so a lot of intense imagery or auditory input or both,

00:45:29.740 | that is going to lead to a situation

00:45:32.180 | where dopamine is going to be depleted afterwards.

00:45:34.780 | - Correct.

00:45:35.620 | - A guest on this podcast before my colleague at Stanford,

00:45:37.760 | Dr. Anna Lemke, who's an expert in addiction,

00:45:39.600 | talked a bit about this, this sort of seesawing.

00:45:41.900 | Here we're talking about a wave

00:45:42.900 | and a crashing out of the water from the wave pool there.

00:45:45.100 | It was a seesawing from pleasure and pain.

00:45:47.920 | There's going to be a longer and deeper period

00:45:51.040 | of lack of pleasure following that.

00:45:53.480 | And I think a lot of people think, oh, well, that's great.

00:45:55.520 | They want the intense experience.

00:45:57.240 | But if that intense experience is coming

00:45:58.840 | from pornography and masturbation,

00:46:01.280 | or I suppose coming from high adrenaline activities

00:46:03.980 | like life-risking parkour

00:46:07.220 | hanging off the side of a building,

00:46:09.060 | it inevitably is going to lead to depressive episodes,

00:46:12.080 | low libido episodes that follow, is that right?

00:46:14.720 | - Correct, in a similar physiologic way

00:46:17.780 | to withdrawal from stimulants like amphetamines.

00:46:21.800 | - Now, is sex with a partner different?

00:46:25.480 | Because there are many people who are chasing

00:46:28.420 | more and more intense experiences with a partner

00:46:31.120 | as opposed to through pornography and masturbation.

00:46:33.200 | Again, here we're talking about all ages.

00:46:34.520 | And I should always say,

00:46:35.360 | anytime we're talking about sex with a partner,

00:46:37.660 | we're talking, you know, the four conditions

00:46:40.080 | that I always lay out on the Huberman Lab Podcast

00:46:43.180 | are that we're talking about consensual, age-appropriate,

00:46:45.800 | context-appropriate, species-appropriate interactions.

00:46:49.040 | - Yeah, and this is also a case

00:46:51.640 | where the dose makes the poison.

00:46:53.940 | So if there's, you know,

00:46:56.240 | obviously meeting all those criteria,

00:46:59.200 | if they have one preference that for both of them

00:47:04.200 | is a positive experience, then that is likely okay.

00:47:08.220 | You're not gonna be able to maintain dopamine

00:47:12.480 | over a certain threshold for a long period of time.

00:47:15.880 | So there very well may be a crash from that experience

00:47:18.560 | as well, and the crash may be different

00:47:21.600 | in one partner than the other.

00:47:24.080 | - Interesting.

00:47:25.040 | Oh, I'll draw an analogy to food.

00:47:26.600 | It'd be like, you know, you don't have to serve

00:47:27.960 | a banquet meal seven nights of the week, maybe just two.

00:47:31.360 | Is that right?

00:47:32.200 | And there are other delicious foods out there.

00:47:34.240 | Can we use that analogy?

00:47:35.400 | - That is very reasonable.

00:47:36.680 | - Okay, not trying to be PG-13,

00:47:38.080 | just trying to, parsimony, Occam's razor,

00:47:42.020 | the ability to describe a lot of things in a few words.

00:47:46.300 | I'd like to return to the key things that people should do,

00:47:50.520 | or I should say the key things that men should do

00:47:52.640 | to optimize their hormones.

00:47:53.720 | So we talked about getting some movement,

00:47:55.080 | getting some sunlight, getting quality social connection,

00:47:57.600 | one way or the other.

00:47:58.960 | Avoid excessively frequent masturbation

00:48:01.800 | and viewing pornography.

00:48:03.040 | And for some people, zero might be the optimal number.

00:48:07.300 | And I keep coming back to this for most people.

00:48:09.880 | Interesting.

00:48:10.720 | I feel so fortunate to have grown up prior

00:48:12.740 | to the availability of internet pornography.

00:48:14.720 | I've never been a big consumer of pornography.

00:48:16.680 | I've just not been my thing.

00:48:18.220 | But I hear so often from males of all ages

00:48:21.760 | about their addiction to it, their affliction by it.

00:48:24.680 | It's really a serious issue.

00:48:26.800 | And that's one of the reasons why I'm grateful

00:48:28.340 | that you're willing to talk about this

00:48:29.600 | and your clinical experience with these patients.

00:48:32.160 | I'd like to take a quick break

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00:48:50.820 | and the reason I still take Athletic Greens

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00:49:46.640 | In terms of exercise, you know, here's, again,

00:49:48.440 | it's a double-edged sword.

00:49:50.280 | On the one hand, it's great to get exercise,

00:49:51.920 | but I'm familiar with, you know, if I train an hour a day,

00:49:56.680 | you know, 10 minutes of warmup

00:49:57.700 | and 50 minutes to an hour of weight training

00:49:59.880 | or 50 minutes to an hour of cardio, I feel great,

00:50:02.320 | especially if once a week I take a complete day off.

00:50:04.560 | That's sort of my general schedule.

00:50:06.120 | I'm also familiar with when I go out

00:50:08.600 | for runs that are excessively long, two-hour runs,

00:50:11.340 | or I spend 90 minutes in the gym too frequently,

00:50:14.200 | I start to feel like garbage.

00:50:15.720 | Everything suffers.

00:50:16.560 | My sleep starts to suffer.

00:50:17.600 | It doesn't matter how much I eat.

00:50:19.280 | I don't seem to recover.

00:50:20.460 | I don't feel well.

00:50:21.760 | - So I realize that recovery ability

00:50:23.760 | varies between individuals,

00:50:25.240 | but what do you think is a healthy,

00:50:27.520 | sustainable exercise regimen that anyone can follow

00:50:32.200 | that will also support their hormone status?

00:50:35.640 | - For really vigorous exercise,

00:50:37.840 | around three to four times a week is very sustainable

00:50:40.920 | over a long period of time.

00:50:43.000 | On top of that, you could add in three or four more instances

00:50:47.000 | of less vigorous exercise.

00:50:48.920 | - Okay, so for less vigorous, what do you mean that,

00:50:50.800 | you know, zone two cardio where you can hold a conversation,

00:50:53.480 | but beyond which you can't, and for more vigorous,

00:50:56.240 | you're thinking weight training

00:50:57.760 | or high intensity interval type training.

00:51:00.600 | Is that right?

00:51:01.420 | - Correct.

00:51:02.260 | You can also weight train and have some benefit,

00:51:05.560 | even at a low to moderate intensity.

00:51:08.280 | If you think about weight training where you have,

00:51:11.520 | and it's not necessarily related to the incidence of DOMS,

00:51:14.200 | which is delayed onset muscle soreness,

00:51:16.720 | but if you weight train lazy or easy from time to time,

00:51:20.800 | obviously you want to weight train very heavy

00:51:22.600 | from time to time as well

00:51:23.540 | because of more lean body mass growth.

00:51:26.880 | But if you weight train lighter,

00:51:29.480 | you're going to be able to do it more often,

00:51:32.320 | and it can still help with the hypertrophy of collagen,

00:51:37.280 | for example, in tendons and ligaments.

00:51:39.900 | - So here again, like to perhaps drill into this notion

00:51:43.880 | of intensity and lightweights,

00:51:45.280 | because for me, some of the most brutal workouts

00:51:47.480 | I've ever done were in what I would consider

00:51:49.660 | a high repetition range, 15 to 50.

00:51:51.680 | Actually, I went up to Oregon

00:51:52.960 | to watch the international track and field championships.

00:51:55.400 | We went by Cameron Hanes' place, the Cameron Hanes,

00:52:00.400 | and he and his trainer put us through a workout

00:52:03.520 | that was 25 to 50 repetitions per set,

00:52:06.720 | and it was done in circuit and it was brutal.

00:52:08.580 | So it was light.

00:52:09.720 | I mean, those weights were nothing.

00:52:12.020 | In some cases it was body weight,

00:52:13.680 | but the number of repetitions was brutal.

00:52:15.720 | So when you say limiting intensity,

00:52:17.880 | are you talking about limiting the number of sets

00:52:20.500 | to failure?

00:52:21.340 | Are you talking about really being kind of a lazy bear

00:52:24.920 | in the gym?

00:52:25.760 | I like to do that every once in a long, long rest,

00:52:27.680 | that sort of thing.

00:52:29.240 | What are your thoughts on that

00:52:30.640 | as it relates to hormone optimization?

00:52:32.500 | So I'll just mention, and then I'll let you answer.

00:52:35.160 | I feel best overall when I'm training

00:52:38.120 | for 10 minute warmups and about 45 or 50 minutes

00:52:40.880 | of weight training where I'm pretty lazy between sets

00:52:43.560 | two to three minute rest,

00:52:45.560 | training somewhere in the six to 10 rep range,

00:52:48.200 | going to failure every once in a while,

00:52:49.820 | but mostly getting that sort of last rep

00:52:51.640 | before what I would think is failure,

00:52:53.000 | no forced reps, that kind of thing.

00:52:54.720 | And then jogging on the other days, nice and easy.

00:52:56.840 | When I do that, I feel fantastic

00:52:58.920 | in all other dimensions of life.

00:53:00.580 | When I train more intensely than that,

00:53:03.700 | even with lightweight, so faster cadence and lower rest,

00:53:08.700 | I feel like garbage.

00:53:10.080 | I get a headache, I'm kind of ornery,

00:53:12.880 | everything suffers.

00:53:14.340 | So what are your thoughts on kind of

00:53:16.120 | defining a optimal exercise strategy for hormones?

00:53:19.960 | I've never measured my hormones

00:53:21.020 | in those two different contexts,

00:53:22.000 | but I have to imagine that it's cortisol related.

00:53:24.840 | - When they study the effect of exercise,

00:53:27.520 | specifically vigorous exercise,

00:53:29.920 | one area that's been studied is

00:53:32.120 | vigorous exercise episodes lasting longer than an hour.

00:53:36.160 | And they usually track it by a rating of perceived exertion,

00:53:39.960 | which isn't perfect and it's not extremely actionable,

00:53:42.680 | but it's helpful for clinical science.

00:53:44.480 | But the takeaway from that is basically do not,

00:53:47.900 | it is not hormonally helpful to train,

00:53:52.640 | especially regularly train vigorously

00:53:55.960 | for longer than an hour.

00:53:57.840 | - Great, so I'm happy to hear that

00:53:59.740 | because it sounds like for most people,

00:54:01.160 | that hour of work is really the threshold.

00:54:04.840 | I think this is important for people to hear,

00:54:06.560 | especially males, because I think

00:54:09.000 | with all of the incredible examples out there

00:54:11.200 | of people like Cam, like David Goggins,

00:54:13.640 | people who are training for very long periods of time,

00:54:16.360 | you know, and leaving aside all issues

00:54:19.040 | of what people are doing in order to optimize their recovery,

00:54:21.960 | I think an hour a day of exercise is just a great program

00:54:25.920 | that most anyone can follow.

00:54:29.160 | And beyond an hour, you start running into challenges.

00:54:33.240 | And I, you know, the occasional 90 minute

00:54:35.360 | or two hour workout is no big deal.

00:54:37.720 | But if you start doing that more than once every

00:54:40.920 | two months, I think you're headed for trouble.

00:54:42.960 | Have you seen that in people's blood work

00:54:45.000 | and in their hormones?

00:54:46.240 | Do you ever see people that are just badly over-trained

00:54:48.560 | because they're just training too hard and too often?

00:54:50.880 | - Yes, when the blood work is particularly bad,

00:54:55.200 | they're often in a large caloric deficit as well.

00:54:59.320 | There's a synergistic effect between a caloric deficit.

00:55:03.480 | Even if you're maintaining adequate protein intake,

00:55:05.940 | you might not be maintaining adequate iron intake

00:55:08.640 | or adequate vitamin D.

00:55:11.040 | And you're also just literally in a caloric deficit,

00:55:13.720 | perhaps low carbs as well, very low free testosterone.

00:55:17.920 | And they're simultaneously doing a lot of vigorous exercise.

00:55:22.920 | - Interesting.

00:55:24.200 | I often hear, and I'm starting to wonder whether or not

00:55:27.080 | some of the quicker to result nutrition tactics,

00:55:32.080 | things like dropping all carbohydrates,

00:55:36.260 | or the quicker to result exercise habits,

00:55:39.820 | like starting to do six day a week, really intense workouts,

00:55:43.000 | whether or not in the short run they work

00:55:45.180 | because they cause the cosmetic changes

00:55:46.920 | that people are seeking,

00:55:48.140 | but that they really undermine the overall goal,

00:55:50.920 | which is, at least to me, to have your hormones,

00:55:54.840 | maybe not optimized to the 100%,

00:55:57.500 | but to always be aiming for 100% and be close to it

00:56:00.700 | at every stage of life.

00:56:02.440 | - Consistency is key here.

00:56:04.540 | If you are not consistent, then the law of diminishing

00:56:07.880 | returns certainly applies.

00:56:09.620 | So 80 or 90% of the benefit over many, many months

00:56:14.620 | is far better than 100%, but only half the time.

00:56:20.540 | - Yeah, one thing that I've found to be tremendously useful

00:56:23.440 | is to finish the workout while I still have energy,

00:56:26.880 | to not take myself to exhaustion.

00:56:28.920 | And then I'm able to kind of talk about

00:56:30.600 | the dopamine wave pool.

00:56:31.560 | I'm able to sort of ride that into the rest of the day,

00:56:34.120 | feeling great.

00:56:34.960 | I sort of save or bank some of the vigor from the training

00:56:39.200 | to bring it into my work.

00:56:40.240 | But then again, I'm not an athlete.

00:56:41.600 | I get paid to think and to speak,

00:56:43.320 | not to lift weights or to run.

00:56:45.940 | - Another component of that is the balance

00:56:47.800 | between your sympathetic,

00:56:49.400 | which is your fight or flight nervous system,

00:56:51.320 | and your parasympathetic,

00:56:52.560 | which is your rest or digest nervous system.

00:56:55.400 | There is an anecdote which is likely true

00:56:57.880 | that many elite bodybuilders are very parasympathetic

00:57:02.200 | besides while they're lifting weights.

00:57:04.040 | - You mean they're lazy and they like to eat a lot.

00:57:05.840 | - Yeah.

00:57:06.680 | - The lazy bear in the gym kind of phenomenon.

00:57:08.320 | - Absolutely.

00:57:09.200 | But that being said, after a very, very vigorous workout,

00:57:13.800 | for example, one where you're trained to failure,

00:57:15.820 | which bodybuilders and power lifters do all the time,

00:57:18.880 | you feel the tiredness or you feel the strain

00:57:23.880 | from that heavy sympathetic activity

00:57:27.040 | when you are lifting a heavy weight.

00:57:29.060 | And it can potentially affect

00:57:31.320 | how you feel the rest of the day.

00:57:32.760 | So many people who have a job where

00:57:36.040 | that is highly cognitive do not like to have

00:57:38.480 | an extremely vigorous workout in the morning,

00:57:40.640 | which is when a lot of people are able to exercise.

00:57:43.600 | - When I exercise early in the morning,

00:57:45.160 | that is before 9 a.m., I have more energy all day long.

00:57:47.960 | If I do it mid-morning,

00:57:48.940 | I have experienced more of an afternoon crash.

00:57:51.000 | There's probably some circadian biology in there.

00:57:53.720 | I've also noticed, and I've actually seen in my blood work,

00:57:56.760 | that if I don't get out for a 45-minute jog

00:58:00.080 | at least once a week, all of my blood profiles suffer

00:58:03.880 | in the direction that I don't want them to go.

00:58:05.800 | In particular, testosterone and estrogen move

00:58:07.920 | in directions that are not conducive to my goals.

00:58:10.560 | I'd like to talk about some of the approaches

00:58:15.040 | that people can use in order to optimize hormones.

00:58:17.360 | And these days, for better or for worse,

00:58:20.200 | I think for worse, younger guys are asking about

00:58:25.200 | and using testosterone replacement therapy, so-called TRT.

00:58:29.240 | And I just want to frame this up by saying

00:58:30.920 | there is no strict cutoff for what is TRT.

00:58:33.240 | There are plenty of people whose blood levels

00:58:36.240 | of testosterone and estrogen

00:58:37.440 | are within the normal reference range

00:58:39.280 | and decide to start doing these things.

00:58:41.040 | Of course, they can limit fertility.

00:58:42.400 | There are a bunch of issues, even at non-quote-unquote

00:58:45.240 | steroidal performance-enhancing dosages.

00:58:49.240 | I'd love to frame this up by first defining our terms,

00:58:51.440 | because one of the challenges on the internet

00:58:53.480 | is people talk about TRT,

00:58:54.720 | then they'll talk about performance-enhancing drugs,

00:58:56.400 | they'll talk about steroids.

00:58:57.600 | They're all steroids, right?

00:58:59.220 | I mean, testosterone, estrogen are both steroid hormones,

00:59:02.600 | but what one considered replacement therapy

00:59:05.680 | versus what one considers performance-enhancing

00:59:08.760 | is going to depend, right?

00:59:10.360 | So here's my question.

00:59:12.380 | Why in the world, why in the world

00:59:17.360 | would any male in his teens or 20s or even 30s

00:59:22.360 | whose blood levels of testosterone and estrogen

00:59:26.520 | are at the appropriate levels,

00:59:27.760 | meaning within the normal reference range,

00:59:29.560 | why would they take exogenous testosterone

00:59:33.660 | given all the negative effects on fertility,

00:59:36.880 | some of the challenges that it can present

00:59:38.520 | if the dosages aren't quite right, et cetera,

00:59:40.880 | why would they do that?

00:59:42.120 | Certainly if they are not being paid

00:59:45.280 | for a particular endeavor, like they're not making money.

00:59:48.240 | If they are playing a sport,

00:59:49.160 | chances are they're not allowed to do that anyway.

00:59:50.860 | It's on the banned substances list.

00:59:53.240 | So to me, it just seems like a crazy idea.

00:59:56.260 | But then again, I'm of a generation

00:59:58.480 | that really hasn't thought about doing that stuff

01:00:00.800 | until people were in their 40s and 50s or even never.

01:00:04.760 | So is there ever a case for somebody in their 20s or 30s

01:00:08.400 | to take testosterone, if their blood levels

01:00:11.480 | are within the 300 to 900 nanograms

01:00:14.960 | per deciliter reference range?

01:00:16.680 | - Not many cases.

01:00:18.280 | The reason for any performance-enhancing drug,

01:00:21.160 | whether or not it is a steroid synthetic bio-identical

01:00:24.740 | or otherwise, it varies a lot.

01:00:27.880 | Some individuals do it only for cosmetic reasons,

01:00:31.960 | even if it can have deleterious effects

01:00:35.560 | on the cosmetic appearance, for example,

01:00:38.600 | of your skin in the long run.

01:00:40.760 | But everyone has their different reason

01:00:44.520 | as far as when does the benefit outweigh the detriment?

01:00:49.480 | Not very often if you're in your 20s,

01:00:52.080 | and certainly probably almost hardly never.

01:00:54.960 | There's always rare cases like Kalman syndrome and whatnot,

01:00:58.840 | but almost never if you were very young.

01:01:02.440 | - Okay, so for people in their 20s, 30s, and beyond,

01:01:05.020 | 40s, et cetera, whose testosterone and estrogen levels

01:01:08.960 | are at the appropriate ratios

01:01:10.720 | and within the normal reference range,

01:01:13.500 | and they feel pretty good, right?

01:01:14.920 | We talked about the ADAMS exam,

01:01:16.240 | where they sort of like feel pretty good

01:01:17.540 | as sort of code for libido, energy, recovery, et cetera,

01:01:21.340 | are feeling at least workable for their lifestyle.

01:01:26.340 | For those people, what can they do besides get great sleep,

01:01:31.640 | train but not too hard or too often, et cetera, et cetera?

01:01:34.220 | What are some of the things in the realm of supplementation

01:01:36.620 | that can help them optimize their testosterone and estrogen

01:01:40.620 | without suppressing their own endogenous production

01:01:44.360 | of testosterone and estrogen?

01:01:46.620 | - Let's mention creatine as the first one.

01:01:49.060 | Creatine is interesting because it has multiple different

01:01:51.520 | effects that helps with amino acid synthesis.

01:01:54.320 | It also helps with oxidative stress.

01:01:56.840 | It can also serve as the backup fuel tank

01:01:59.080 | for your mitochondria.

01:02:00.120 | So kind of holding back up ATP,

01:02:02.560 | and it does slightly increase total testosterone,

01:02:05.760 | and it also increases the conversion of testosterone

01:02:08.400 | to dihydrotestosterone.

01:02:10.340 | So potentially it's especially useful in men

01:02:14.280 | in even their teenage years and their 20s.

01:02:17.640 | - You mentioned the conversion of testosterone

01:02:19.280 | to dihydrotestosterone, and there is mythology out there

01:02:22.460 | that creatine can increase hair loss.

01:02:24.140 | I'm guessing because there's at least one study showing

01:02:26.540 | that creatine can increase DHT, dihydrotestosterone,

01:02:29.760 | and DHT is one of the primary hormones

01:02:32.920 | that can promote male pattern baldness.

01:02:35.680 | So the question therefore is,

01:02:38.260 | does creatine supplementation increase the rate of hair loss?

01:02:44.080 | - Theoretically it can, but in each individual,

01:02:49.080 | preventing hair loss is a very poor reason

01:02:53.480 | to take creatine because it's not going to take you

01:02:55.640 | to a supra physiologic level.

01:02:58.440 | It's not going to increase your androgens

01:03:03.040 | to an unnormal level of binding.

01:03:05.840 | So I feel like if that was a reason to not take creatine

01:03:11.320 | for hair loss, then that's-

01:03:13.420 | - Sorry, you mean hair loss is not a reason

01:03:15.400 | to avoid taking creatine?

01:03:17.260 | - Correct, hair loss is not a reason

01:03:19.120 | to avoid taking creatine.

01:03:21.500 | Think of it as just bringing you

01:03:23.920 | to what you are naturally inclined to have.

01:03:27.600 | If your conversion of testosterone to DHT is already high,

01:03:31.420 | then often creatine does not affect this.

01:03:34.580 | It just kind of resets your balance

01:03:36.640 | between testosterone being aromatized to estrogen

01:03:39.860 | or being five alpha reduced DHT.

01:03:42.980 | So it's not going to speed up hair loss

01:03:44.640 | more than just naturally being a male does.

01:03:48.000 | So in some individuals, it will have no effect.

01:03:50.760 | In some individuals, for whatever reason,

01:03:52.840 | they have almost no five alpha reductase activity.

01:03:55.560 | It will return them to natural or normal.

01:03:58.080 | - I see.

01:03:58.900 | Well, I take five grams a day of creatine monohydrate.

01:04:01.560 | I do it for the tissue volumizing effects,

01:04:05.360 | for exercise benefits, but also for the cognitive effects.

01:04:08.200 | I don't know if it's increasing my hair loss.

01:04:10.040 | I mean, I've got a little bit

01:04:10.880 | of sort of a widow's peak type hair loss.

01:04:13.360 | That's where it is for me.

01:04:14.660 | I suppose beard growth is associated with DHT too.

01:04:18.780 | Is that right?

01:04:20.020 | What I learned, but then again,

01:04:21.420 | I haven't been into this literature in a long time,

01:04:23.140 | is that because of differences in receptors

01:04:25.920 | that DHT causes hair growth on the face

01:04:28.320 | and hair loss on the head.

01:04:29.660 | Is that right?

01:04:30.640 | - Yes, and the amount and the sensitivity

01:04:33.200 | and density of those receptors is genetically determined.

01:04:37.440 | - And is it true that if your mother's father was bald,

01:04:40.560 | that you will be bald in the same pattern

01:04:42.420 | and if that he wasn't, you won't?

01:04:44.440 | - That is a decent correlation.

01:04:47.760 | Part of the proposed mechanism of this,

01:04:49.680 | well, there are several genes

01:04:50.880 | and you can actually test your genes for hair loss.

01:04:53.600 | You do get a decent amount of them from your mother.

01:04:56.320 | The unique thing you get from your mother

01:04:58.240 | that she may have gotten from her father,

01:05:00.620 | that she got one of the copies from her father

01:05:02.360 | is your X chromosome.

01:05:03.920 | And the androgen receptor gene is on your X chromosome.

01:05:07.560 | So all men got their androgen receptor gene

01:05:11.480 | from their mother.

01:05:12.840 | - It's on their X chromosome, not on the Y chromosome.

01:05:15.320 | - Correct.

01:05:16.200 | - Interesting.

01:05:17.040 | Even though all of the sort of quote unquote,

01:05:19.220 | male promoting genes are on the Y chromosome,

01:05:23.440 | like malaria and inhibiting, et cetera.

01:05:25.460 | Interesting.

01:05:26.440 | Okay, so five grams a day of creatine for most people

01:05:29.000 | should be fine, beneficial for tissue voluminizing,

01:05:32.320 | so strength, bringing water into the muscles

01:05:35.160 | and for the cognitive effects

01:05:37.860 | and the clinical support of creatine,

01:05:39.660 | I think is quite strong at the five gram per day dosage.

01:05:42.800 | What other sorts of supplements can people benefit from?

01:05:45.980 | We already talked about the omegas

01:05:47.680 | and making sure that people are getting enough

01:05:49.080 | prebiotic fiber to support the gut microbiome and vitamin D.

01:05:54.040 | So what other supplement-based tools can people consider?

01:05:58.360 | - Another one we can loop in with creatine is betaine.

01:06:01.040 | Some people are non-responders to creatine,

01:06:03.440 | so you can increase that to 10 grams

01:06:06.000 | or you can use its cousin betaine

01:06:07.920 | to help with amino acid synthesis and shunting of energy.

01:06:12.320 | Along with that, I would put L-carnitine,

01:06:15.160 | which is actually the smallest peptide hormone.

01:06:18.300 | It's just two amino acids that are put together.

01:06:20.820 | So it's a-

01:06:21.660 | - It's a hormone.

01:06:23.080 | Interesting.

01:06:24.080 | I'm not challenging it.

01:06:24.920 | - Peptide.

01:06:25.740 | - Yeah, I'm not challenging.

01:06:26.580 | - I would call it a peptide more than a hormone.

01:06:29.200 | So I would not call L-carnitine a hormone,

01:06:31.880 | but I would call dopamine a hormone.

01:06:33.840 | - Yeah, I could.

01:06:34.880 | A neurohormone, it's so hard to define things

01:06:37.920 | as transmitters or hormones at some level.

01:06:39.920 | I agree.

01:06:40.760 | So L-carnitine, actually, I should backtrack.

01:06:43.600 | Betaine, do you recall what dosage

01:06:47.520 | people typically would take

01:06:49.000 | if they're a creatine non-responder?

01:06:51.400 | - One to three grams.

01:06:52.880 | In fact, yeah.

01:06:54.000 | Several versions of creatine have betaine mixed in

01:06:57.120 | because it helps with the processing

01:06:59.020 | of methionine and homocysteine.

01:07:00.880 | - So if somebody is already taking creatine

01:07:03.080 | and likes it and responds to it,

01:07:04.680 | I'll raise my hand, such as myself,

01:07:06.580 | would adding betaine help

01:07:08.600 | or is it redundant with creatine?

01:07:11.040 | - Only if their homocysteine is persistently elevated.

01:07:13.740 | And homocysteine is kind of like an inflammatory marker

01:07:16.240 | that can build up if you're not converting

01:07:18.320 | enough of it down the stream.

01:07:19.780 | - How would I know?

01:07:21.360 | - Just a blood test.

01:07:22.520 | - Okay.

01:07:23.360 | - Or if you knew your MTHFR polymorphism,

01:07:25.880 | which is basically how you add methyl groups

01:07:29.840 | to many things in the body.

01:07:32.280 | - Great.

01:07:33.120 | Any side effects of betaine that people should be aware of?

01:07:36.360 | - Not that I know of.

01:07:37.280 | - Okay.

01:07:38.100 | People can look it up.

01:07:38.940 | And on examine.com is a great site for that.

01:07:40.620 | They'll surely list it.

01:07:41.700 | They just revamped their site, by the way.

01:07:43.280 | And it was awesome before and it's platinum now.

01:07:46.920 | So L-carnitine, what are the ways to take L-carnitine?

01:07:51.760 | I know that there's an oral form, so capsules,

01:07:54.040 | and there's injectables.

01:07:55.040 | The injectables, I think you need a prescription.

01:07:57.200 | Is that right?

01:07:58.040 | - Correct.

01:07:58.860 | You need a prescription for the injectables,

01:08:00.280 | or you should really get a prescription for the injectables.

01:08:03.980 | When you inject it, of course,

01:08:06.660 | at the supervision of your doctor,

01:08:08.140 | it's usually done intramuscularly.

01:08:10.040 | It's an aqueous solution.

01:08:11.860 | So it does not have like an oil or a carrier oil in it,

01:08:14.360 | like testosterone esters do.

01:08:17.700 | However, if you inject it too superficially,

01:08:20.840 | it's not going to make or rake anything.

01:08:22.360 | Often it just burns if you inject it subcutaneously.

01:08:25.600 | And it does not disseminate throughout the body as well.

01:08:29.400 | L-carnitine potentially has localized effects

01:08:32.940 | if you inject it.

01:08:34.460 | If you ingest it orally,

01:08:36.740 | then it has a very low bioavailability, maybe only 10%.

01:08:40.780 | - Well, I think most people are going to be able

01:08:42.300 | to get L-carnitine only in its capsule form.

01:08:46.260 | So what are the dosages of L-carnitine

01:08:47.960 | that one needs to ingest then if they want to get a benefit?

01:08:51.140 | Because if only 10% is being absorbed,

01:08:54.900 | that's probably a lot of L-carnitine.

01:08:56.420 | How much should people take per day?

01:08:58.140 | - Usually I recommend for oral L-carnitine

01:09:00.800 | between 1,000 milligrams and up to four or 5,000 milligrams.

01:09:05.700 | - So one to four, maybe even five grams.

01:09:08.800 | - Correct, up to five grams a day.

01:09:11.040 | If you're on that much,

01:09:12.340 | especially if you have a dysregulated gut microbiome,

01:09:16.020 | you should be concerned with TMAO,

01:09:17.900 | which is a potential carcinogen

01:09:19.600 | that both carnitine and choline can convert into.

01:09:23.260 | And your gut microbiota determine how much that happens.

01:09:27.420 | - Is it true that I can offset any negative effects

01:09:29.820 | of alpha-GPC-choline, that is NL-carnitine,

01:09:34.420 | that I take by ingesting garlic, is that right?

01:09:37.340 | - There's a compound in garlic called allicin.

01:09:39.860 | I believe it's A-L-L-I-C-I-N.

01:09:42.180 | It's also part of the scientific name,

01:09:43.720 | the genus of types of garlic.

01:09:46.980 | And this can help decrease the conversion to TMAO.

01:09:49.980 | Berberine actually slightly decreases

01:09:51.780 | the conversion to TMAO as well,

01:09:54.180 | probably through alteration of the gut microbiome.

01:09:56.740 | And then just optimizing your gut microbiome

01:09:59.340 | can decrease conversion.

01:10:00.340 | So not everyone needs allicin,

01:10:02.460 | but it's something that you should certainly consider

01:10:04.380 | if you were on a high dose.

01:10:06.500 | - I'm going to continue to take the 600 milligrams of garlic

01:10:10.420 | every time I take my L-carnitine,

01:10:12.060 | but I'm going to skip the berberine

01:10:13.380 | 'cause berberine gives me brutal headaches

01:10:15.020 | and it makes me crave carbohydrates

01:10:16.500 | because it drops my blood sugar.

01:10:17.980 | - It has many other effects, including the DAWN phenomenon,

01:10:20.900 | where it drops your blood sugar when you're sleeping

01:10:22.760 | and you can't even realize it.

01:10:24.240 | - I am not a fan of berberine,

01:10:26.040 | and I'm sorry for those of you that are.

01:10:28.340 | I'm not trying to offend anyone,

01:10:29.660 | although frankly, if you're being offended

01:10:31.580 | by my stance on berberine,

01:10:33.580 | then maybe we should have another discussion.

01:10:35.720 | In any case, injectable L-carnitine,

01:10:38.220 | if one can get that through a doctor,

01:10:39.720 | how much is absorbed and how much should one take?

01:10:43.800 | - Almost all of it's absorbed.

01:10:45.040 | In general, you're taking between 500 milligrams up to,

01:10:49.280 | you can take a pretty high dose, up to 2000 milligrams.

01:10:52.320 | - Okay, and what we did not talk about

01:10:54.640 | is what L-carnitine does.

01:10:56.500 | So why should someone go through all of this?

01:10:59.020 | Is it to optimize testosterone?

01:11:00.780 | Is it working on the receptor side?

01:11:03.340 | What's L-carnitine doing?

01:11:05.440 | - It's a shuttle.

01:11:06.420 | So I think it's named carnitine palmitoyl coenzyme A.

01:11:10.960 | Basically, it just takes nutrients

01:11:13.400 | from outside your mitochondria and puts them in.

01:11:16.340 | It also has a unique effect.

01:11:18.040 | Well, not too unique because tadalafil

01:11:19.880 | actually has this effect as well,

01:11:21.580 | is that it increases the density of the androgen receptor

01:11:25.160 | in the cytoplasm of your cells.

01:11:27.960 | So even if your androgen receptor sensitivity

01:11:30.400 | doesn't change, and even if your testosterone

01:11:32.880 | does not change, you will have more testosterone

01:11:35.740 | binding to that increased number of receptors.

01:11:38.260 | - Does one need to cycle L-carnitine, creatine, betaine?

01:11:42.300 | - No reason to cycle any of those.

01:11:45.180 | - Okay, what other supplements can one use

01:11:47.600 | to try and improve hormone profiles?

01:11:50.220 | And here, I realize we're using a very broad brush

01:11:53.040 | because when we say improve hormone profiles,

01:11:54.760 | what are we really talking about?

01:11:56.280 | And for me, at least, I think about the subjective stuff.

01:12:00.680 | Do people feel like they are going to have more energy

01:12:04.460 | as a consequence of doing these things?

01:12:06.120 | Are they going to have the more optimized libido?

01:12:09.100 | Are they going to have more optimized recovery from exercise?

01:12:12.720 | Because, I mean, it's not clear to me

01:12:14.440 | that taking one's testosterone from 600 to 800

01:12:17.040 | is always going to be a good thing,

01:12:18.160 | especially if estrogen is increasing in parallel,

01:12:20.960 | that could cause issues.

01:12:22.400 | It could certainly make things better.

01:12:23.920 | It could certainly make things worse, right?

01:12:26.240 | So with that backdrop,

01:12:29.620 | what are some of the other things people can take?

01:12:31.360 | And then we'll go back to this issue

01:12:32.320 | of what really is optimization.

01:12:34.400 | - Let's briefly mention vitamin D, which is also a hormone.

01:12:37.320 | It's actually a sterile hormone.

01:12:39.280 | And if you have deficient vitamin D and you replace it,

01:12:42.960 | then you will optimize your testosterone.

01:12:45.960 | Let's also mention boron.

01:12:47.200 | So if you have a very high SHBG,

01:12:49.080 | boron can acutely help lower it,

01:12:51.120 | usually in a dose of five to 12 milligrams per day.

01:12:54.600 | It's not really a sustained effect,

01:12:56.600 | but boron is depleted in soils.

01:12:59.320 | In many countries, I believe it's very high in soils,

01:13:01.920 | in Greece and Turkey.

01:13:03.060 | So eating dates or raisins that are from those areas

01:13:05.640 | potentially have more boron.

01:13:07.440 | Boron also might be one of the reasons

01:13:09.740 | why the reference range for testosterone

01:13:12.480 | is much higher in those countries than other countries.

01:13:16.360 | - And just to remind people

01:13:17.440 | that SHBG, sex hormone-binding globulin,

01:13:19.760 | is attaching to the testosterone molecule

01:13:22.000 | and limiting the amount of so-called free testosterone

01:13:24.300 | that's available to have its impact on cells.

01:13:26.720 | Dr. Peter Attia was on this podcast,

01:13:28.880 | in fact, sitting in that very chair.

01:13:30.560 | He said that the ideal level of free testosterone in males

01:13:34.260 | should be about 2% of one's total testosterone.

01:13:37.760 | Would you agree with that number or disagree?

01:13:39.640 | I'm sure Peter would be fine if you said either.

01:13:43.000 | - 2% is a good rule of thumb.

01:13:44.460 | Usually the reference range is between about 1% and 4%.

01:13:48.400 | Some people do have genetic polymorphisms in SHBG,

01:13:52.260 | a specific gene mutation where they have very low SHBGs.

01:13:57.260 | Also men that have varicose veins in their testes,

01:14:00.260 | also known as varicocele, tend to have very high SHBGs.

01:14:04.640 | So that percentage would likely be less than 2%.

01:14:07.640 | So just because your percentage of free T to total T

01:14:12.640 | is a little bit above or below 2%, that's okay.

01:14:17.280 | We just need to figure out the reason why it is.

01:14:19.720 | - How would somebody know if they have varicose veins

01:14:21.800 | in their testicles, especially if their testicles

01:14:25.000 | are still attached to their body?

01:14:27.920 | - Sometimes it's hard to tell.

01:14:30.040 | There is several grades.

01:14:31.440 | If you have a grade three or a grade four varicocele,

01:14:35.480 | it has what's called a bag of worms appearance.

01:14:37.840 | So think about if you've just resistance trained

01:14:40.360 | or it's a really hot day

01:14:42.120 | or you're wearing very tight fitting clothing,

01:14:44.800 | then if you feel it, it almost feels like there's worms

01:14:47.760 | in the scrotum.

01:14:49.440 | The other way is to do-

01:14:50.280 | - Is a scary visual.

01:14:51.720 | - Yeah, bag of worms.

01:14:53.960 | - Well, it was just that, yeah, anyway,

01:14:55.480 | I think parasites when I hear that,

01:14:57.140 | but that's not what you're referring to.

01:14:58.200 | You're talking about just the texture.

01:15:01.580 | - The best way for most people to check is to Valsalva

01:15:05.460 | for a long period of time.

01:15:06.940 | When you Valsalva, venous return will decrease.

01:15:11.160 | - Can you explain Valsalva for people?

01:15:12.720 | - It's bearing down like you're lifting a weight

01:15:14.640 | or having a bowel movement where you swallow.

01:15:18.880 | And a lot of times you can almost see buildup of blood

01:15:23.880 | in your like jugular veins as well.

01:15:26.520 | So you have decreased blood return to the heart

01:15:30.240 | and increased blood in the veins themselves.

01:15:34.960 | I'd like to take a brief break

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01:15:48.160 | I've long been a believer in getting regular blood work done

01:15:50.820 | for the simple reason that many of the factors

01:15:53.240 | that impact your immediate and long-term health

01:15:55.260 | can only be analyzed from a quality blood test.

01:15:57.840 | The problem with a lot of blood and DNA tests out there,

01:15:59.920 | however, is that you get data back about metabolic factors,

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01:16:10.840 | what sorts of nutritional, behavioral,

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01:16:17.860 | in order to adjust the numbers of those metabolic factors,

01:16:20.440 | hormones, lipids, and other things

01:16:22.240 | that impact your immediate and long-term health

01:16:24.200 | to bring those numbers into the ranges

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01:16:39.580 | Okay, so vitamin D3.

01:16:41.240 | I'm guessing you're talking about vitamin D3 specifically

01:16:43.420 | when you say vitamin D.

01:16:44.880 | And then boron, five to 12 milligrams per day, right?

01:16:49.040 | And then what are some of the other things

01:16:50.680 | to optimize testosterone that are in supplement form?

01:16:54.220 | - We can talk about things

01:16:56.320 | that affect the steroidogenesis cascade.

01:16:58.300 | So we could touch on Tongkat Ali.

01:16:59.840 | I know we've talked about that a little bit before.

01:17:01.680 | - Yeah, but I'm guessing a number of people

01:17:03.140 | probably haven't heard that conversation.

01:17:05.240 | - Also known as long jack,

01:17:07.000 | and that upregulates several different enzymes

01:17:10.040 | in the steroidogenesis cascade.

01:17:12.120 | And by that, what you mean if,

01:17:14.740 | and this is another good thing to Google,

01:17:16.180 | I think anybody interested in hormone optimization

01:17:18.360 | should understand where sterile hormones come from.

01:17:22.280 | They come usually from cholesterol

01:17:24.480 | and they can be shunted off to vitamin D very easily.

01:17:27.320 | They can be shunted off to testosterone or estrogens

01:17:30.580 | or progestogens quite easily as well.

01:17:33.720 | But Tongkat helps with the conversion

01:17:36.240 | of multiple key steps where you synthesize testosterone.

01:17:41.240 | Another, think of it as like a coenzyme or a cofactor,

01:17:46.120 | an upregulator of these steps is insulin and IGF-1.

01:17:50.860 | So a good rule of thumb is if you are not expecting

01:17:54.360 | as much growth hormone, insulin and IGF-1,

01:17:57.160 | for example, lower carb diets, caloric deficits,

01:18:01.000 | you're trying to cut body fat or body weight,

01:18:03.780 | then Tongkat is going to be theoretically

01:18:06.860 | especially powerful.

01:18:09.220 | - What sorts of dosages of Tongkat

01:18:11.020 | do you recommend to your patients?

01:18:13.260 | - Anywhere from 300 to 1200 milligrams a day.

01:18:17.420 | With Tongkat, you need to be careful

01:18:19.820 | with the standardization because,

01:18:22.540 | and if you're thinking about a general Tongkat supplement,

01:18:25.100 | which is by far the most well-studied,

01:18:27.720 | then you're looking at the uricominone content,

01:18:32.200 | which is a plant compound that is likely

01:18:34.860 | the main active pharmacologic effect.

01:18:38.260 | So that's the compound that's having the effect on the body.

01:18:41.580 | And if you standardize the uricominone very, very high,

01:18:46.000 | then theoretically you're having more effect at a lower dose.

01:18:49.960 | - I take 400 milligrams of Tongkat Ali per day.

01:18:53.080 | I take it early in the day

01:18:54.060 | because it has a bit of a stimulant effect.

01:18:55.700 | And if I take it after 2 p.m.,

01:18:57.240 | it starts to inhibit my sleep.

01:18:59.580 | I've been taking it for years,

01:19:01.840 | and I rather like the effects.

01:19:05.020 | It seems subtle, but consistent.

01:19:07.460 | I've never cycled it.

01:19:09.400 | Do you recommend cycling it?

01:19:11.380 | - I don't see any reason to cycle it.

01:19:13.420 | There is a reason to cycle some supplements,

01:19:17.640 | but no reason to cycle Tongkat.

01:19:19.760 | - My blood work tells me that it causes an increase

01:19:22.100 | in free testosterone for me,

01:19:23.860 | and also a slight increase in luteinizing hormone for me.

01:19:27.980 | What are some of the other effects on various hormones

01:19:30.300 | that you've observed in the blood work of your patients

01:19:32.700 | taking Tongkat Ali?

01:19:33.900 | - Tongkat can also slightly increase DHEA.

01:19:38.340 | And if you have a very high SHBG,

01:19:41.180 | again, that's the protein that binds up your androgens

01:19:43.860 | and estrogens, an extremely important protein.

01:19:46.700 | The higher your SHBG, the more it helps decrease it.

01:19:51.260 | So they've studied Tongkat in populations

01:19:54.660 | with very normal SHBGs, and it does nothing for SHBG.

01:19:59.000 | - Interesting.

01:19:59.840 | Does that mean it does nothing for somebody overall?

01:20:02.100 | So if somebody has SHBG that's in the normal range,

01:20:05.100 | will taking Tongkat benefit them in any other way?

01:20:08.220 | - Yes, it'll increase their total and free testosterone.

01:20:12.180 | - Got it.

01:20:13.820 | Okay, is it known to have effects on anything else,

01:20:16.240 | like thyroid hormone, growth hormone,

01:20:18.000 | or is it purely in these steroid synthesis pathways?

01:20:21.280 | Or steroid, I should say,

01:20:22.960 | synthesis and receptor and modulation pathways?

01:20:25.760 | - There's no direct effect on those pathways.

01:20:28.280 | However, anytime you alter your free androgen

01:20:32.180 | or free estrogen,

01:20:34.600 | particularly one without altering the other,

01:20:37.620 | it will alter the binding protein

01:20:39.280 | that binds thyroid hormones.

01:20:41.040 | So any change you make,

01:20:42.740 | whether it's natural optimization or hormone replacement,

01:20:45.920 | you're going to slightly skew your thyroid hormone profile.

01:20:49.200 | One common actionable example of this

01:20:51.660 | that I see often clinically is someone starts,

01:20:55.920 | let's say estrogen replacement or testosterone replacement.

01:20:59.400 | Maybe they're taking an AI

01:21:00.600 | with their testosterone replacement.

01:21:02.280 | - Aromatase inhibitor.

01:21:04.240 | - Correct, an aromatase inhibitor

01:21:05.480 | which blocks the conversion to estrogen.

01:21:07.900 | If they're taking testosterone

01:21:09.720 | and they have very little estrogen,

01:21:12.480 | then you're going to decrease the binding protein,

01:21:15.320 | also known as thyroxine binding globulin,

01:21:17.960 | which binds active thyroid hormones.

01:21:20.600 | So if you start TRT

01:21:24.120 | and you either have low aromatase activity

01:21:26.580 | or no aromatase activity, no conversion to estrogen,

01:21:30.320 | then your free thyroid hormones will go up,

01:21:33.340 | even just acutely, usually feedback inhibition,

01:21:36.700 | which is how the body talks to itself and says,

01:21:39.880 | we need to make more of this or less of this.

01:21:42.440 | But acutely, there's not always enough time.

01:21:46.160 | You're going to have very high thyroid hormones

01:21:49.460 | and you can have tachycardia, which is a fast heart rate,

01:21:52.800 | or you can feel kind of like overly fight or flight

01:21:55.520 | due to increased thyroid hormone activity in the end tissue.

01:21:59.560 | - Interesting.

01:22:00.640 | Okay, so Tongali, this is a broad range,

01:22:03.160 | 300 to 1200 milligrams per day.

01:22:05.200 | And I realized that the source matters there.

01:22:07.440 | What are some of the other hormones

01:22:10.360 | that you prescribe to your patients

01:22:13.200 | who do not want to go on testosterone replacement therapy

01:22:16.280 | or take exogenous DHEA or anything like that?

01:22:19.340 | - We can talk about Fidosia next.

01:22:22.520 | Fidosia is interesting because it's a genus of plants.

01:22:25.160 | Fidosia aggressive is one of them.

01:22:27.080 | There's many others that are very interesting.

01:22:30.320 | That species is likely the most well-studied

01:22:32.840 | and it will increase LH.

01:22:35.200 | So I would not consider it an LH memetic.

01:22:38.560 | So it doesn't really mimic it,

01:22:40.100 | but it increases the release of luteinizing hormone

01:22:42.400 | from the pituitary.

01:22:43.260 | That's a hormone that binds to the latex cell,

01:22:46.480 | to the LH receptor, kind of like HCG does.

01:22:49.720 | And it will increase the release of testosterone.

01:22:53.340 | - I see.

01:22:54.180 | So I think for people that aren't familiar with HCG,

01:22:56.480 | so human chorionic gonadotropin

01:22:58.160 | is basically synthetic luteinizing hormone.

01:23:00.440 | And luteinizing hormone is the hormone released

01:23:02.100 | from the pituitary that is going to travel down

01:23:04.480 | to the testes to stimulate the production of sperm

01:23:07.520 | and testosterone, but mainly testosterone.

01:23:09.780 | Is that correct?

01:23:10.620 | - Mostly correct.

01:23:13.460 | Technically synthetic LH is also known as little R LH

01:23:16.880 | or recombinant LH.

01:23:18.440 | And HCG can be synthetic,

01:23:21.160 | but often it is just refined from the urine

01:23:23.720 | of pregnant ladies since the placenta makes it.

01:23:27.760 | That's why it's called chorionic gonadotropin.

01:23:30.960 | - So where are they getting all this pregnant women's urine?

01:23:35.100 | I mean, is there a location?

01:23:38.040 | I mean, not that I want to go there.

01:23:39.160 | I'm just, really?

01:23:40.580 | So they're women that are sending-

01:23:41.420 | - First trimester pregnant ladies, it's very high.

01:23:43.520 | - Donating their urine and then they're purifying it

01:23:47.040 | and then men are injecting it.

01:23:49.080 | - Yes.

01:23:50.000 | - Wow.

01:23:50.840 | - And that's actually the same for menopausal ladies.

01:23:53.200 | So first trimester pregnant ladies,

01:23:55.280 | that's how you can make, you know, non-synthetic HCG.

01:24:00.280 | And then for menotropins, which are also known,

01:24:04.160 | there's a couple of different names for it.

01:24:05.760 | Like Minopure, you have menopausal ladies

01:24:08.760 | that have very high LH and FSH,

01:24:10.720 | and then you refine the FSH and LH.

01:24:13.400 | - Okay, so moving away from the sources and from urine,

01:24:18.400 | Fidogia agrestis, what dosages do you have patients take?

01:24:23.080 | I've heard of some potential toxicity

01:24:26.000 | to the testicular cells.

01:24:27.600 | - There was one study, and this is a rat study,

01:24:30.040 | but you can equate the dose of toxicity in rats and humans.

01:24:34.080 | They did not give these rats any antioxidants,

01:24:37.040 | but it increases a couple different

01:24:39.080 | like pro-inflammatory markers.

01:24:41.900 | One is GGT or gamma-glutamyltransferase,

01:24:45.080 | comes from both the testes and the liver,

01:24:46.840 | and one is alkaline phosphatase, also known as Alkphos,

01:24:50.640 | again, coming from both areas.

01:24:52.740 | There are several different ways

01:24:53.840 | that you can attenuate this increase,

01:24:55.580 | and you can also just check to see if you have increased.

01:24:58.640 | In the rat dose that equates with humans that had no effect,

01:25:02.480 | so the safe dose, was an average of 300 milligrams a day.

01:25:06.800 | - So that would be 300 milligrams a day in humans

01:25:09.960 | is the dosage that did not have toxicity, correct?

01:25:13.200 | - Correct, and often, even if there is toxicity in rats,

01:25:17.780 | there is not toxicity in humans,

01:25:19.320 | so it's not directly equitable, but to be safe,

01:25:23.480 | another regimen that I have people take

01:25:25.280 | is 600 milligrams every other day,

01:25:27.520 | or 600 milligrams three times a week,

01:25:30.020 | often Monday, Wednesday, Friday.

01:25:32.200 | - This is very interesting and relevant

01:25:34.200 | because I've been taking Fidogia for some period of time,

01:25:37.480 | all my markers and tests indicate that there's no toxicity,

01:25:41.720 | but I've been taking 600 milligrams per day,

01:25:45.360 | but I've been cycling it for about eight to 12 weeks on,

01:25:49.220 | and then a few weeks off, but based on what you're saying,

01:25:51.960 | I'm thinking maybe three times per week,

01:25:54.000 | or every other day might be better, is that right?

01:25:56.600 | - If you weren't going to get any labs,

01:25:58.500 | that is certainly the regimen that you want.

01:26:00.420 | If you're going to check your GGT and Alkphos,

01:26:03.440 | or even take other things to prevent those from increasing,

01:26:06.880 | then you can certainly be more aggressive

01:26:09.740 | with your Fidogia dosing.

01:26:11.980 | You can increase it quite a bit,

01:26:13.560 | and it has a dose dependent response

01:26:16.260 | in both the activities associated with high testosterone

01:26:19.000 | and also just LH and testosterone.

01:26:22.280 | So the more aggressive regimen would be 600 milligrams daily

01:26:26.080 | for a month, and then take one to two weeks off.

01:26:29.180 | - Great, I think that's more or less what I've been doing.

01:26:32.480 | Okay, terrific.

01:26:33.880 | In terms of other hormones,

01:26:35.400 | what are some of the supplements

01:26:36.520 | that can support growth hormone, right?

01:26:38.720 | A hormone that's associated with tissue repair,

01:26:40.840 | and in some cases, metabolism and fat loss.

01:26:43.900 | What are some of the tools,

01:26:45.800 | nutritional and/or supplement based,

01:26:48.040 | one can do to tap on the growth hormone pathway?

01:26:52.280 | And let's lump IGF-1 in there too,

01:26:54.360 | since they're essentially working along the same dimensions.

01:26:57.880 | - A quixinopsis growth hormone is a peptide hormone,

01:27:00.820 | and it is released by the pituitary.

01:27:04.240 | There's growth hormone releasing hormone

01:27:06.480 | and a ghrelin that stimulate the release.

01:27:08.400 | So there's also peptides that are very analogous

01:27:11.360 | to these two things.

01:27:13.360 | You have that pulsatile secretion of growth hormone

01:27:16.440 | in a very fast half-life of just minutes,

01:27:18.480 | and then it increases IGF-1.

01:27:20.780 | There is both peripheral IGF-1 and central IGF-1 and IGF-2,

01:27:24.440 | but no need to get into the specifics.

01:27:27.440 | There is a happy medium to where your growth hormone

01:27:30.860 | is at a adequate level and your IGF-1 is an adequate level.

01:27:34.700 | Usually those two are congruent.

01:27:36.460 | So in most cases, we just check an IGF-1

01:27:39.580 | and occasionally the binding peptides for IGF-1,

01:27:42.460 | kind of like SHBG that we talked about earlier,

01:27:45.220 | but you're estimating a free IGF-1.

01:27:48.100 | It's kind of confusing because almost all hormones

01:27:52.440 | have binding proteins to help regulate them,

01:27:55.440 | but often you want to look at free testosterone,

01:27:57.620 | free estradiol, free IGF-1, or at least estimate it,

01:28:01.520 | free cortisol even, and free thyroid hormone.

01:28:04.620 | But when you're talking about growth hormone and IGF-1,

01:28:10.520 | usually you don't need to do anything to optimize it.

01:28:14.200 | If you are diabetic, then depending on the type of diabetes,

01:28:19.200 | your IGF-1 and growth hormone can be too high.

01:28:23.520 | Specifically in type 1 diabetes,

01:28:25.760 | your growth hormone is extremely high,

01:28:27.600 | but your IGF-1 is low.

01:28:29.960 | So if you're in a dysregulated state or have pathology,

01:28:33.000 | I would just talk to your doctor about IGF-1

01:28:35.000 | or growth hormone.

01:28:36.400 | Taking thing, taking amino acids before you go to bed

01:28:39.380 | could potentially help with growth hormone release

01:28:42.200 | just because most growth hormone is released

01:28:45.880 | while you sleep.

01:28:47.220 | - I've heard that fasting can increase growth hormone,

01:28:49.920 | and I know there are certain patterns of weight training

01:28:52.920 | that can increase growth hormone.

01:28:54.600 | Some of those regimens in the weight room

01:28:57.040 | that increase growth hormone have been covered

01:28:59.520 | by Dr. Duncan French, who is a guest on this podcast.

01:29:04.520 | So maybe we'll refer people to that episode

01:29:08.840 | for the specific protocols, these high volume training.

01:29:12.260 | - During those training exercises,

01:29:13.840 | it usually does it transiently for a period of a few hours.

01:29:17.680 | And a lot of this IGF-1 is released by the muscle itself.

01:29:22.700 | So it's not necessarily released by the liver.

01:29:25.460 | IGF-1 that is released directly

01:29:27.960 | due to growth hormone signaling,

01:29:29.340 | usually the growth hormone comes from the pituitary

01:29:31.800 | and binds to the liver,

01:29:33.440 | where it usually has a half-life of about a week,

01:29:35.880 | where the paracrine or autocrine,

01:29:37.660 | think of it as like the peripherally acting

01:29:39.880 | or acting in the muscles itself, which is also helpful,

01:29:43.660 | is released and is not as concerning

01:29:47.040 | because it's not related to insulin resistance,

01:29:50.680 | but it is related to the training itself.

01:29:53.380 | - So fasting and growth hormone,

01:29:56.120 | is it true that fasting can increase growth hormone?

01:29:59.720 | And maybe as a little related tangent,

01:30:03.580 | I've heard that limiting food intake

01:30:05.380 | for the two hours before going to sleep

01:30:07.180 | can increase the pulse of growth hormone

01:30:08.880 | that one experiences during sleep.

01:30:10.700 | Of course, everyone gets a pulse of growth hormone

01:30:12.260 | during sleep, but especially carbohydrate-laden meals

01:30:15.440 | can blunt that peak that occurs

01:30:18.380 | during sleep quite substantially.

01:30:19.740 | So two questions, does avoiding food intake

01:30:24.440 | in the two hours prior to sleep

01:30:26.000 | help increase growth hormone release?

01:30:28.160 | Maybe it's being overly neurotic.

01:30:29.480 | Maybe people need to avoid food

01:30:31.280 | in the four hours before sleep.

01:30:33.320 | But regardless, what is the relationship

01:30:35.800 | between fasting and growth hormone release?

01:30:37.480 | I find this really interesting.

01:30:38.800 | - Fasting certainly potently increases

01:30:41.660 | growth hormone release.

01:30:43.280 | However, the end binding to the receptor is less sensitive.

01:30:49.380 | So although fasting does increase growth hormone,

01:30:53.400 | the genes that are downstream to it,

01:30:55.800 | both the growth hormone genes

01:30:57.200 | and IGF-1 related gene transcription activity

01:31:01.920 | will not be significantly higher.

01:31:04.640 | However, if you are optimizing the growth hormone

01:31:08.660 | that is released as a pulsatile secretion,

01:31:12.380 | it is helpful to avoid eating for two hours.

01:31:15.000 | So the general rule of thumb

01:31:16.160 | is avoid eating about two hours before bed.

01:31:18.060 | I think that's clinically significant and helpful,

01:31:20.640 | but fasting otherwise specifically

01:31:22.760 | for growth hormone optimization

01:31:24.560 | in someone who already has normal growth hormone signaling

01:31:27.960 | is not helpful.

01:31:29.240 | - That's extremely useful to hear

01:31:32.080 | because one of the major reasons why people fast

01:31:34.620 | is to get that growth hormone increase.

01:31:35.920 | But if they're adjusting things on the backend

01:31:38.860 | that negate that, well then no such luck.

01:31:42.940 | Not that I have anything against fasting.

01:31:44.520 | I do a pseudo intermittent fasting,

01:31:46.440 | mostly 'cause I prefer to eat at fairly regular times of day.

01:31:50.200 | Okay, so it doesn't sound like there's a lot

01:31:52.660 | that people can take in supplement form

01:31:54.660 | to improve growth hormone.

01:31:55.780 | What about thyroid hormone?

01:31:56.820 | What are some of the things that people can take or do

01:31:58.900 | in order to make sure that their thyroid hormone levels

01:32:01.660 | are appropriate?

01:32:03.360 | - You want to have a balance of iodine

01:32:06.520 | and you want to have a good source of iodine.

01:32:08.180 | So there's some camps that say

01:32:09.800 | you should use a huge high dose of iodine

01:32:12.700 | and there's protocols for it.

01:32:14.260 | And there's some that say you should use

01:32:15.820 | just barely enough iodine.

01:32:17.620 | I believe it's like 200 micrograms per day.

01:32:20.380 | But you want to balance.

01:32:22.260 | One of the things that I see that many people

01:32:24.860 | do not talk about when it comes to iodine and thyroid

01:32:28.680 | is there's compounds known as goiterogens or goitrogens.

01:32:33.220 | And these goitrogens are neither good nor evil,

01:32:36.160 | but they're actually kind of a nice check and balance.

01:32:39.500 | You need more iodine if you consume more goitrogens.

01:32:42.620 | And some examples of these are some of my favorite foods,

01:32:46.420 | cruciferous vegetables, boron is also a goitrogen.

01:32:50.600 | So higher goitrogens, higher iodine.

01:32:53.660 | - So ingesting iodine containing salt is useful?

01:32:58.420 | Yes or no?

01:32:59.260 | - Iodized salt does prevent goiter,

01:33:02.920 | but it is not necessarily the ideal form of iodine.

01:33:07.060 | Good forms of iodine often come from the ocean.

01:33:09.700 | If you look at a chart of hypothyroidism,

01:33:12.460 | there is a tendency to have more hypothyroidism

01:33:14.980 | the more inland you go.

01:33:16.180 | - So trying to eat some cruciferous vegetables each day

01:33:20.900 | would be the best way to improve thyroid hormone?

01:33:24.260 | - Along with plenty of iodine.

01:33:26.020 | You don't want too much iodine signaling.

01:33:27.940 | Many people are familiar with radioactive iodine tablets,

01:33:31.340 | and that's basically an extremely high amount of iodine

01:33:33.980 | to block out the radioactive iodine

01:33:38.180 | that comes from after like a nuclear meltdown or whatnot.

01:33:42.060 | - So we've got creatine, betaine,

01:33:44.880 | l-carnitine with allicin, garlic to offset the TMAO,

01:33:49.880 | vitamin D3, boron, tonga, alifadogia, some fasting.

01:33:55.180 | Love to talk to you about peptides.

01:33:58.180 | So I can imagine a hierarchy.

01:33:59.900 | Hierarchy starts with behaviors and nutrition.

01:34:03.540 | Behaviors of course includes training and limiting stress

01:34:05.660 | and all the things we talked about before,

01:34:08.180 | sunshine, et cetera, and optimized nutrition.

01:34:12.420 | Then we talked about supplements,

01:34:15.200 | all the things we just listed off to optimize testosterone.

01:34:18.980 | And we can get into this, but estrogen as well,

01:34:21.580 | which is important for libido and brain function

01:34:23.540 | and tissue function and joints feeling good, et cetera.

01:34:26.500 | But then we get into the realm where one might

01:34:29.020 | or could consider exogenous hormones,

01:34:31.400 | get taking a small dose of testosterone

01:34:33.220 | or taking a small dose of GH even if, you know,

01:34:36.840 | if that were appropriate and certainly

01:34:38.580 | only working with a doctor.

01:34:39.580 | But in between, there's a step of so-called peptides.

01:34:43.020 | And of course there are many peptides.

01:34:44.360 | We've already talked about some of them,

01:34:45.820 | but when people talk about taking peptides,

01:34:47.400 | the ones that I hear most often about is a category

01:34:51.140 | that increases GH and IGF-1.

01:34:55.620 | And those, to my knowledge,

01:34:57.900 | go by the things like sormorelin, ipramorelin,

01:35:02.000 | tesamorelin, sort of a kit of things

01:35:04.700 | that taken separately or in combination

01:35:07.380 | to increase GH and IGF-1.

01:35:09.540 | But then other people, for instance,

01:35:11.020 | are taking peptides like BPC-157

01:35:14.260 | to try and improve tissue healing and recovery.

01:35:17.420 | There's a lot of interest in peptides.

01:35:19.900 | Please, if you would, tell us about what you know

01:35:22.740 | about the safety of peptides in terms of their sourcing

01:35:25.700 | and the utility of peptides.

01:35:27.240 | You know, is this something that people should consider

01:35:29.580 | before thinking about hormone replacement?

01:35:31.640 | Should people be wary of these things?

01:35:33.560 | I am very wary of particular sources that are sold online

01:35:36.400 | that are not clean.

01:35:37.860 | They contain contaminants and it could be dangerous.

01:35:40.280 | I really would love your thoughts on peptides.

01:35:42.380 | I'm just going to sit back and let you riff on peptides.

01:35:45.700 | But if you could touch on some of the ones that I mentioned,

01:35:47.780 | I'd be most grateful.

01:35:50.000 | - A peptide is just a chain of amino acids

01:35:52.860 | between two and a couple hundred in length.

01:35:56.080 | So I think of peptides as several different categories.

01:35:59.580 | And the GHRPs that you mentioned,

01:36:02.000 | I would consider those, and that stands for

01:36:04.100 | Growth Hormone Releasing Peptide.

01:36:06.880 | You have two main types.

01:36:08.800 | The ghrelin agonist, or they hit the ghrelin receptor

01:36:13.800 | and it helps release growth hormone because of that.

01:36:18.020 | And then also the GHRH-like peptides.

01:36:21.940 | So they're very similar to growth hormone releasing hormone.

01:36:24.580 | Often they just change a couple amino acids

01:36:27.420 | and it acts like that.

01:36:29.380 | Tessamoralin is one of them, sermorelin is another one,

01:36:32.940 | and CJC is another common one.

01:36:36.280 | I believe those are all in the class of GHRH-like peptides,

01:36:40.240 | whereas ibomirelin or ibutamorin,

01:36:43.020 | which is also known as MK677,

01:36:45.620 | those two are in the class of ghrelin agonists.

01:36:48.720 | So they're more like,

01:36:49.920 | they hit the receptor that ghrelin does,

01:36:52.000 | whereas the other ones hit the GHRH receptor.

01:36:54.860 | - I think of ghrelin as making me hungry.

01:36:56.880 | - Hungry and angry.

01:36:57.960 | - Why would I want to take something

01:36:59.220 | that would increase ghrelin signaling?

01:37:01.420 | - Some people are trying to gain weight.

01:37:04.580 | It also does increase your growth hormone.

01:37:06.700 | So if your growth hormone is very low, you can consider it.

01:37:09.840 | Ibutamorin is a long-acting, so it has a long half-life,

01:37:13.480 | also known as MK677.

01:37:15.480 | It was studied mostly in growth hormone deficiency.

01:37:19.860 | - And do these people get angry also?

01:37:22.440 | - They can.

01:37:23.340 | Many people report a side effect of anxiety

01:37:27.480 | or significant hunger.

01:37:29.240 | Most people take it in the evening

01:37:31.200 | so they don't notice that hunger as much.

01:37:33.760 | It can also greatly increase your blood glucose.

01:37:36.460 | So if you're insulin resistant

01:37:37.720 | or pre-diabetic gets especially concerning.

01:37:40.260 | - This is one of those rare moments where I hear something

01:37:43.760 | and I think, okay, even though there's this kit of compounds

01:37:48.760 | that can increase GH and IGF-1,

01:37:50.520 | based on everything you're telling me,

01:37:52.560 | maybe just taking GH is the better option for those people

01:37:56.040 | because growth hormone, at least it's,

01:37:58.080 | synthetic growth hormone is mimicking an endogenous hormone.

01:38:01.160 | I mean, certainly not taking anything might be the ideal,

01:38:04.800 | but for those that want to increase growth hormone

01:38:06.600 | and they want to use pharmacology to do that,

01:38:08.880 | it sounds like these peptides are pretty precarious.

01:38:11.840 | - Yeah, it kind of depends on the situation.

01:38:14.720 | If there's an individual that struggles with hunger

01:38:19.320 | and not eating it enough, for example,

01:38:21.540 | someone who has a very small stomach

01:38:25.200 | or they just have a very low hunger drive,

01:38:28.080 | sometimes you want more of that orexigenic signaling.

01:38:32.080 | The hypothalamus, you have anorexigenic signaling,

01:38:34.720 | which is kind of like anorexia and orexigenic signaling,

01:38:37.880 | which is, I call it the hangry center of the hypothalamus

01:38:42.400 | or the hangry center.

01:38:44.100 | And if there's an imbalance between those two,

01:38:46.520 | then perhaps it'd be helpful,

01:38:49.200 | potentially theoretically helpful in anorexics

01:38:52.040 | of which the incidence of anorexia in men is increasing

01:38:55.640 | significantly.

01:38:56.760 | - As you're telling me this,

01:38:57.600 | I'm remembering being 14 or 15 years old

01:38:59.880 | and I would go into the kitchen sometimes

01:39:02.160 | and I was so hungry, I would just obliterate all the food.

01:39:05.640 | And I do remember being,

01:39:07.080 | I've always been a pretty high energy guy,

01:39:08.500 | but having an immense amount of energy.

01:39:10.400 | I don't, I can't recall if it was a hangry feeling or not,

01:39:12.680 | but I'm guessing that was growth hormone.

01:39:13.800 | I grew one foot in a single academic year.

01:39:16.400 | So I imagine that was at least in part due to growth hormone.

01:39:20.560 | - In any case, Surmorellin is the peptide

01:39:23.400 | that I hear that most often about.

01:39:25.560 | I admittedly tried a run of it.

01:39:27.800 | I was researching a book and decided to take it

01:39:31.140 | before sleep on an empty stomach.

01:39:33.280 | It gave me a tremendous depth of sleep,

01:39:37.640 | but that sleep was really truncated,

01:39:39.600 | which is just nerd speak for saying deep, but short sleep.

01:39:42.240 | I would wake up after very intense dreams.

01:39:44.520 | I can't say that it helped me recover

01:39:46.300 | from exercise that much.

01:39:47.420 | I didn't notice any additional fat loss or anything.

01:39:50.160 | - Sort of abandoned it except for occasional use.

01:39:52.560 | Again, this was prescribed by a doctor.

01:39:54.520 | You know, I was trying to get the sense

01:39:57.880 | that these peptides and their effects are somewhat vague

01:40:00.640 | and distributed and highly individual.

01:40:02.600 | Is that a fair way to describe them?

01:40:05.120 | - Part of the problem with the effect of peptides

01:40:08.420 | is many people take them in levels

01:40:11.040 | that are far above the physiologic range.

01:40:15.240 | Even individuals who are checking their IGF-1

01:40:18.160 | while they take these different GHRPs,

01:40:22.240 | most of them do not check the binding peptides.

01:40:25.240 | For example, IGF binding peptide one, two, or three,

01:40:29.200 | and their free IGF-1 level might be significantly different.

01:40:33.800 | So the common doses that people will take these off-label

01:40:38.760 | for as a supplement are often much greater

01:40:42.320 | than the therapeutic or physiologic range.

01:40:45.360 | - Which for me just underscores the fact

01:40:47.080 | that it's pretty precarious.

01:40:48.160 | I mean, I'm not coming in here as the referee

01:40:50.360 | of what anyone should or shouldn't do.

01:40:52.680 | Just trying to gather and distribute information.

01:40:55.080 | But I've heard, for instance, that some companies

01:40:58.060 | where people can acquire these things without prescription,

01:41:00.760 | those companies are not good at cleaning out

01:41:03.240 | the lipopolysaccharide, the LPS,

01:41:06.000 | which can cause an inflammatory response.

01:41:08.120 | In other words, these are dirty compounds.

01:41:10.840 | And that just sounds risky.

01:41:12.920 | It just sounds, frankly,

01:41:14.760 | it just sounds really dangerous to me.

01:41:16.600 | - LPS is a common additive in many companies

01:41:20.560 | that are not pharmacies, but they're selling things

01:41:24.400 | that people often use as human consumption.

01:41:27.080 | One interesting note about lipopolysaccharide

01:41:29.460 | is your gut microbiome actually makes a lot of it as well,

01:41:32.760 | especially Prevotella, which is a specific species

01:41:36.640 | that can have to do with your baseline body temperature.

01:41:40.540 | So your baseline body temperature might also change

01:41:43.640 | depending on if you're on a peptide that has LPS in it.

01:41:46.840 | - Yikes, yikes, and yikes.

01:41:50.160 | But I tend to be pretty conservative

01:41:52.000 | when it comes to taking anything exogenous.

01:41:54.400 | But I do rely on many of the supplements

01:41:56.360 | that we talked about earlier,

01:41:57.320 | and I do try and optimize the behavioral things

01:41:59.360 | and nutritional things for a long time.

01:42:02.000 | Okay, so then leaving peptides behind,

01:42:06.480 | we are now, I suppose, in the territory

01:42:08.640 | of exogenous hormone.

01:42:10.160 | So let's say that somebody decides

01:42:13.480 | they're not concerned with fertility,

01:42:14.840 | or they're going to bank sperm, or they already have kids,

01:42:17.680 | or they're going to defer on this issue

01:42:19.620 | of wanting to have kids.

01:42:21.160 | My understanding is that nowadays,

01:42:22.860 | a lot of people are using testosterone,

01:42:24.920 | let's not even call it replacement therapy,

01:42:26.580 | 'cause some of these people have 600, 700,

01:42:29.280 | or even 800 nanogram per deciliter reads.

01:42:32.200 | So they're not replacing anything that is diminished.

01:42:35.000 | They're just trying to augment what's already there,

01:42:36.960 | increase what's already there.

01:42:38.460 | My understanding is that taking a low dose more frequently

01:42:42.080 | is going to be more beneficial than the kind of old school way

01:42:45.220 | of giving 100 or even 200 milligrams in a single injection

01:42:49.080 | once every two weeks.

01:42:50.280 | Is that right?

01:42:51.120 | And what do you do with your patients?

01:42:52.560 | So let me give you a hypothetical.

01:42:53.860 | Somebody comes into your office,

01:42:54.980 | they do their blood work and they have blood levels

01:42:59.980 | of let's say 600 nanograms per deciliter of testosterone.

01:43:03.580 | Their estrogen is also in normal range.

01:43:06.160 | Everything else checks out,

01:43:07.600 | but they're complaining of slightly diminished libido,

01:43:10.900 | slightly poor recovery from workouts,

01:43:12.900 | maybe reduced motivation and drive,

01:43:16.100 | although no major depression.

01:43:17.740 | And you come to the conclusion that testosterone therapy,

01:43:21.020 | not replacement, but testosterone therapy

01:43:22.900 | might be a good option to explore.

01:43:24.340 | What's a typical dosage range

01:43:27.060 | and frequency of administration range

01:43:29.080 | that you might consider exploring?

01:43:31.660 | - And some of this depends on the SHBG

01:43:34.560 | and free testosterone as well.

01:43:35.920 | So if that same individual had a very high SHBG,

01:43:38.760 | which again is the binding protein

01:43:40.280 | that binds up the testosterone

01:43:41.700 | and all androgens and estrogens.

01:43:43.800 | If it is extremely high

01:43:45.300 | and they have a free testosterone of two,

01:43:48.620 | then they might need a different dose

01:43:49.940 | because they need enough testosterone

01:43:51.960 | in order to have a normal ugonadal free testosterone.

01:43:56.960 | But a general normal dosing range,

01:44:00.120 | especially for someone starting,

01:44:01.520 | is around 100 to 120 milligrams

01:44:04.960 | divided over the course of a week.

01:44:07.360 | Usually either every other day or three times a week,

01:44:10.540 | occasionally twice a week.

01:44:12.380 | Many people with SHBG a bit higher

01:44:15.020 | can get away pretty easily with twice a week.

01:44:17.460 | This is assuming that the ester is saponate or enanthate.

01:44:20.600 | - So two 60 milligram injections

01:44:23.200 | of testosterone and saponate per week.

01:44:25.080 | - Yeah, very common dosing.

01:44:26.400 | - To hit that 120 milligrams per week

01:44:28.400 | as kind of the typical average.

01:44:29.880 | - Correct, and I would consider this

01:44:31.960 | like a physiologic ugonadal dose.

01:44:34.400 | For many people, even 200 milligrams a week

01:44:37.440 | is far above the reference range.

01:44:40.000 | All of this is said with the caveat

01:44:41.680 | that testosterone is normally released

01:44:44.280 | in a pulsatile manner.

01:44:45.760 | So it's high in the morning, low in the evening.

01:44:48.040 | Whereas if you're on a testosterone therapy,

01:44:51.400 | then you're going to have a steady state.

01:44:54.880 | So your testosterone level is going to be

01:44:56.760 | pretty much the same even in the evening.

01:44:59.640 | - And in your experience, when patients do that,

01:45:03.380 | I'm guessing they report the normal constellation

01:45:05.480 | of positive effects, you know, improved mood,

01:45:07.360 | improved energy, improved sleep, recovery, et cetera.

01:45:10.760 | What are some of the hazards

01:45:12.440 | or things that can crop up in blood work

01:45:14.880 | or just subjectively that can be warning signs

01:45:18.220 | that even a dosage of 120 milligrams

01:45:20.540 | divided into these two or three dosages per week is too high?

01:45:24.520 | - Every organ system in the body.

01:45:26.360 | So this is when you really have to be

01:45:28.320 | at least well-versed in every organ system,

01:45:32.600 | not just the gonadal, like, you know, genital system.

01:45:37.600 | You need to have, you know, dermatology prowess.

01:45:41.840 | Acne is a very common change.

01:45:44.140 | Lots of different skin pathologies

01:45:46.520 | or even bruising can be related to hormone replacement.

01:45:49.740 | Hair loss is very common to see as well.

01:45:52.760 | Mental status changes.

01:45:54.300 | It could, occasionally it even induces a manic

01:45:57.080 | or a bipolar episode

01:45:58.400 | because testosterone is also dopaminergic.

01:46:01.080 | And then cardiovascularly, not just in the heart,

01:46:04.080 | but also concerns for like

01:46:05.400 | microvascular ischemic disease, ferritin buildup,

01:46:08.840 | because the estrogen also increases.

01:46:11.240 | And then fertility concerns as well and lipid concerns too.

01:46:15.760 | So you really have to be, you know, hematologist,

01:46:17.520 | dermatologist, cardiologist, lipidologist,

01:46:22.360 | the whole nine yards.

01:46:23.600 | - So another reason or set of reasons rather to,

01:46:28.880 | if one is considering using testosterone therapy

01:46:31.360 | to really do this in close communication

01:46:33.920 | with a really good physician,

01:46:35.800 | 'cause that's a lot to monitor.

01:46:36.880 | Knowing whether or not you have acne or not is one thing,

01:46:39.220 | but knowing whether or not your LDL is going up,

01:46:41.160 | your APOB is going up, that's a whole other biz

01:46:43.120 | and that needs to be done through blood work

01:46:44.880 | is what I'm hearing.

01:46:46.180 | - Correct.

01:46:47.020 | And if your physician that is managing

01:46:49.060 | or prescribing your testosterone therapy

01:46:52.540 | or your HRT is not well-versed in these systems,

01:46:56.020 | you would want him or her

01:46:57.200 | to be part of an interdisciplinary team

01:46:59.320 | where they have other experts

01:47:00.640 | that can monitor those systems.

01:47:02.280 | - I skipped over a sort of still intermediate

01:47:06.640 | set of things, prescription drugs,

01:47:08.300 | but maybe talking about testosterone first

01:47:10.800 | was a bit of a mistake on my part,

01:47:12.160 | because I'm aware that there are,

01:47:14.480 | actually I think there are companies,

01:47:15.760 | but certainly groups out there that say,

01:47:17.720 | no wait, don't go straight from nothing to supplements

01:47:21.360 | to testosterone.

01:47:22.200 | Once you're doing behaviors

01:47:23.960 | and optimizing nutrition supplements,

01:47:26.100 | let's forget peptides,

01:47:27.400 | instead of going straight to testosterone therapy,

01:47:30.580 | one idea that many people are pursuing

01:47:32.600 | is to take the prescription drugs

01:47:35.920 | that trigger luteinizing hormones.

01:47:37.400 | So taking HCG, human chorionic gonadotropin,

01:47:41.360 | which my understanding is will increase testosterone,

01:47:44.120 | but also estrogen,

01:47:45.320 | or they'll take things like clomiphene.

01:47:47.880 | In fact, I think there are a bunch of companies out there now

01:47:50.000 | that are saying, don't take testosterone,

01:47:51.920 | it shuts down spermatogenesis,

01:47:53.300 | it shuts down testosterone production,

01:47:56.120 | clomiphene is the way to go.

01:47:57.740 | Maybe you could educate us about the HCG monotherapy,

01:48:01.420 | I think it's called,

01:48:02.260 | where you're just mono, one just taking HCG,

01:48:04.640 | and/or clomiphene as a tool to ratchet up hormones.

01:48:09.640 | - So quick points on HCG.

01:48:14.240 | Human chorionic gonadotropin,

01:48:16.400 | made during especially the first trimester of pregnancy,

01:48:19.200 | it has effects other than binding to the LH receptor.

01:48:23.060 | It also binds to the TSH receptor in the thyroid.

01:48:26.600 | - So thyroid-stimulating hormone.

01:48:28.120 | - Yes.

01:48:28.960 | In fact, if you look at a molecule of HCG

01:48:31.320 | and thyroid-stimulating hormone,

01:48:33.060 | they are extremely similar.

01:48:34.960 | However, you need a relatively high dose of HCG

01:48:38.840 | to bind to the TSH receptor.

01:48:40.400 | This is the normal mechanism in pregnancy

01:48:42.800 | that accounts for the increased need of thyroid hormone,

01:48:45.960 | usually about 30 to 40%.

01:48:48.120 | So that's why if someone has hypothyroidism,

01:48:50.400 | you need to increase their dose of thyroid,

01:48:52.160 | because the HCG is not gonna be doing it for you.

01:48:54.700 | The clomid or clomiphene, there's two main,

01:49:00.080 | I believe it's di-stereoisomers.

01:49:02.520 | And one of them is inclomiphene,

01:49:04.040 | and one of them is zuclomiphene.

01:49:06.380 | And these two work slightly differently.

01:49:09.040 | Inclomiphene, I believe has a faster half-life,

01:49:12.760 | and it is potentially slightly better tolerated.

01:49:16.800 | However, they were studying it.

01:49:19.620 | You know, clomid is a very commonly prescribed drug,

01:49:21.580 | and obviously there is plenty of inclomiphene in clomid.

01:49:26.280 | However, the drug, which was Androzole, A-N-D-R-O-X-A-L,

01:49:31.280 | did not go all the way through the FDA approval process,

01:49:34.160 | despite clomid being FDA-approved.

01:49:36.120 | - Okay, so there's clomid, which contains clomiphene,

01:49:38.980 | but there are also,

01:49:40.400 | 'cause we're talking about male hormone optimization

01:49:43.000 | this episode, there are males out there

01:49:45.540 | who want to increase their testosterone and other hormones,

01:49:49.040 | maybe growth hormone, et cetera,

01:49:51.060 | who opt to not take exogenous testosterone,

01:49:54.100 | so no cream, no pellet, no pill, no injectable cipinate,

01:49:58.600 | but decide to take clomiphene a couple of times a week.

01:50:02.060 | My understanding, I've never done this,

01:50:04.760 | I would say, if I had.

01:50:05.820 | My understanding is that taking clomiphene,

01:50:09.200 | maybe two 50-milligram tablets a week,

01:50:11.900 | is what I hear people are doing,

01:50:13.480 | will increase what, luteinizing hormone,

01:50:16.300 | the various estrogen receptor subunits.

01:50:19.560 | Could you explain how clomiphene would benefit anyone,

01:50:22.000 | and is this a good strategy?

01:50:23.260 | I'm hearing that it's being done quite a lot now.

01:50:26.160 | - It will increase testosterone in a dose-dependent manner,

01:50:30.000 | but it has many other pharmacodynamic effects,

01:50:32.640 | which is the effect of the drug on the body,

01:50:35.100 | other than its effect on the hypothalamus and the pituitary.

01:50:38.060 | So in the hypothalamus and the pituitary,

01:50:40.700 | it does what's called negative feedback inhibition,

01:50:44.900 | or it blocks the oxygen of estrogen,

01:50:48.460 | so it crowds out estrogen from the estrogen receptor

01:50:52.880 | on the hypothalamus and the pituitary.

01:50:55.000 | - And what's the subjective effect that that would cause?

01:50:57.160 | So my understanding and experience of estrogen

01:51:00.140 | is that if I ever took,

01:51:01.960 | and I did take a very low dose

01:51:03.280 | of an aromatase inhibitor once, and I felt terrible.

01:51:05.840 | Actually, reduced libido, joints felt achy,

01:51:09.180 | that's when I discovered that, wow,

01:51:10.640 | estrogen is actually really important

01:51:12.520 | for your brain function, for joint function, and for libido.

01:51:16.240 | And suppressing estrogen for me just turned out

01:51:18.560 | to be the wrong idea, but my levels indicate

01:51:21.040 | that it's within reference range.

01:51:22.920 | Okay, so why would I want to take something

01:51:26.280 | that would increase the activity of an estrogen receptor?

01:51:30.240 | I just can't find the rationale for that.

01:51:33.020 | - The main rationale behind taking a CIRM

01:51:35.820 | is as a very temporary measure

01:51:38.920 | that is not going to suppress pituitary

01:51:41.460 | or hypothalamic function.

01:51:43.320 | If your testosterone is just so drastically low

01:51:47.000 | that it is unlikely to recover anyway.

01:51:50.460 | So most of the time it is not clinically useful

01:51:54.000 | and CIRM should not be prescribed very often,

01:51:57.440 | certainly not as long-term testosterone replacement

01:52:01.320 | or testosterone optimization in most individuals.

01:52:04.340 | There's always exceptions to everything,

01:52:06.720 | but there's five different estrogen

01:52:10.100 | and estrogen-related receptors.

01:52:12.280 | There's two main estrogen receptors in Clomid

01:52:15.720 | and every CIRM has a very unique profile

01:52:19.240 | because they selectively inhibit some receptors

01:52:22.080 | in some tissues, but not other receptors in other tissues.

01:52:25.260 | For example, Clomid can inhibit receptors

01:52:28.600 | that are in the eye and it can cause visual changes,

01:52:32.760 | blurry vision, especially at higher doses.

01:52:37.240 | And it also acts in every other tissue of the body.

01:52:40.640 | So side effects from Clomid

01:52:43.280 | and other selective estrogen receptor modifiers

01:52:46.000 | are very common.

01:52:47.040 | - So I'm, at least by my mind,

01:52:50.320 | I'm going to pool them with peptides

01:52:52.280 | and say it sounds precarious

01:52:53.760 | and probably not ideal for most people.

01:52:56.220 | Going back to testosterone therapy then again,

01:52:59.400 | notice folks I've deleted the replacement part

01:53:01.640 | because I think so many people are using testosterone therapy

01:53:05.680 | without the need to, the sort of reference range need

01:53:09.720 | to replace anything,

01:53:12.920 | but rather building on what they already have

01:53:14.840 | for purposes of increasing vitality, et cetera.

01:53:17.620 | Going back to that,

01:53:19.120 | my understanding is that taking HCG several times per week

01:53:23.400 | can help maintain spermatogenesis and fertility

01:53:25.760 | even while people are on testosterone.

01:53:27.480 | But, and you and I were talking about this earlier,

01:53:29.260 | that there's tremendous variation.

01:53:30.840 | Some people will take a small amount of testosterone

01:53:33.460 | and just crush their sperm count.

01:53:35.320 | They just won't make any viable sperm.

01:53:37.200 | Other people can maintain viable sperm production

01:53:39.880 | while on testosterone, especially if they're taking HCG.

01:53:43.300 | Is that right?

01:53:44.200 | - Correct.

01:53:45.040 | And there's many reasons for this.

01:53:46.080 | Some of this has to do with heat damage to the testes.

01:53:49.320 | So potentially cold therapy could be helpful for that.

01:53:52.080 | - Ice baths, cold showers.

01:53:55.340 | Or just avoid, and certainly avoiding sauna and hot tub.

01:53:59.160 | - Yeah, stopping the daily hot tub

01:54:01.440 | can restore fertility in many people.

01:54:03.480 | - I know a number of people

01:54:05.160 | that are trying to conceive children

01:54:07.000 | that go into the sauna

01:54:09.080 | and they'll just put a cold pack in their shorts

01:54:11.360 | or between their legs,

01:54:12.280 | depending on whether or not they're wearing shorts or not

01:54:13.800 | when they go in.

01:54:15.240 | Or they'll alternate ice and heat

01:54:16.840 | in a way that maintains coolness of the milieu

01:54:20.840 | in which the sperm live.

01:54:24.400 | In other words, they're cooling their scrotum deliberately

01:54:28.280 | in order to avoid killing the sperm.

01:54:30.740 | Actually, I saw an interesting paper

01:54:32.720 | that said that for every two degree increase

01:54:35.140 | in temperature of the scrotum,

01:54:39.140 | there's a 20% decrease in spermatogenesis

01:54:42.180 | and viability of sperm.

01:54:44.480 | And that actually, if you look at the difference

01:54:46.700 | between people who stand a lot, sit a lot, and drive a lot,

01:54:50.380 | what you see is a progressive decrease in sperm count.

01:54:52.800 | Because when people are sitting,

01:54:54.440 | there's an increase in temperature.

01:54:55.540 | And then when they're sitting on the hot seat of the car,

01:54:58.760 | or using the heated seats, actually it kills sperm.

01:55:01.600 | I think there are good data on that.

01:55:03.320 | - Yeah, excellent data, and anecdotally, you see it as well.

01:55:06.660 | I've had several patients come in

01:55:08.660 | for fertility consultations.

01:55:10.740 | And all we do is, no medications, no supplements,

01:55:14.040 | we change their several lifestyle things.

01:55:17.320 | Very tight-fitting clothing is another one.

01:55:21.180 | And soon they have fertility, and they're no longer,

01:55:25.080 | they have sperm, whereas before they did not.

01:55:28.580 | - Interesting.

01:55:29.420 | I'd like to talk about some of the dos and don'ts,

01:55:33.000 | but we have talked about a lot of dos,

01:55:35.400 | things that one can do to optimize hormones.

01:55:37.060 | Maybe we could just do sort of more rapid fire Q&A

01:55:41.460 | on some of the don'ts, and maybe throw in some science

01:55:44.680 | where you feel it's appropriate.

01:55:46.860 | Cannabis, marijuana, THC, yes or no,

01:55:50.980 | it diminishes testosterone levels.

01:55:53.840 | - Smoked cannabis, I would say diminishes testosterone,

01:55:59.160 | increases prolactin, that's a no.

01:56:01.500 | Other cannabinoids, not particularly harmful.

01:56:04.320 | - So CBD?

01:56:05.460 | - CBD, not particularly harmful.

01:56:08.500 | Smoked CBD, I'm not sure.

01:56:11.340 | - What about edible cannabis and THC?

01:56:14.360 | - As far as I know, edible cannabis and THC

01:56:17.020 | does not significantly increase prolactin

01:56:19.700 | to a point where it would be disruptive of hormones.

01:56:23.540 | - Can marijuana, THC, cannabis, whatever you want to call it,

01:56:27.100 | increase gynecomastia, the growth of male breast tissue?

01:56:30.020 | - Yes, it certainly can.

01:56:31.620 | And there's a pretty good association

01:56:33.420 | between smoked THC and gynecomastia.

01:56:36.560 | - What about nicotine and testosterone and estrogen

01:56:41.360 | and other hormones, smoked nicotine?

01:56:44.460 | - Nicotine is particularly concerning,

01:56:46.440 | not only for testosterone, but also for estrogen.

01:56:49.380 | Part of it is if you're talking about nicotine from tobacco,

01:56:52.180 | there's many other carcinogens in it,

01:56:53.880 | especially if it's smoked.

01:56:55.620 | But nicotine, even if it is chewed

01:56:57.700 | in a dose-dependent manner,

01:56:59.220 | so if you can use an extremely small amount of nicotine,

01:57:02.900 | then it's not as concerning in the long run,

01:57:05.260 | but it's a vasoconstructor.

01:57:06.980 | And one of the main concerns with it

01:57:09.220 | would be cardiovascular disease

01:57:11.660 | or even microvascular ischemic disease

01:57:15.920 | that can lead to neurodegenerative disease.

01:57:18.220 | So like a type of dementia

01:57:19.800 | that can be partly due to nicotine.

01:57:22.140 | If you use nicotine for a very long period of time,

01:57:25.820 | especially at a higher dose,

01:57:27.680 | it's a dose-dependent effect on your hormone profile.

01:57:32.660 | - Is that also true for other nicotine gums?

01:57:36.900 | - At high doses, if you can use an extremely low dose

01:57:40.300 | of a nicotine gum,

01:57:42.780 | then theoretically that would be maintainable.

01:57:47.000 | It's not gonna overload the nicotinic receptor.

01:57:50.380 | You have acetylcholine and the cholinergic system

01:57:53.120 | as one of your main nervous systems, of course,

01:57:56.140 | and you have muscarinic receptors and nicotine receptors,

01:57:59.120 | and there's just better ways

01:58:01.180 | to optimize your nicotinic receptor activity.

01:58:04.740 | For example, acetylcholine precursors like alpha-GPC,

01:58:08.020 | phosphatidylserine, phosphatidylcholine,

01:58:11.460 | weak acetylcholinesterase inhibitors,

01:58:13.400 | especially natural ones potentially have a part as well,

01:58:17.040 | and then other alkaloids.

01:58:18.660 | So nicotine is an alkaloid from the tobacco plant.

01:58:21.960 | There is other plants like cytosine,

01:58:24.800 | and that genus of plants,

01:58:27.360 | and that alkaloid is also a nicotine receptor agonist.

01:58:31.280 | - Is it true that cycling for too long,

01:58:36.400 | literally bicycling, sitting on a bike seat too long

01:58:39.420 | can damage the prostate?

01:58:41.620 | - Yes, it can be very concerning,

01:58:43.760 | especially if you're seated while cycling,

01:58:46.480 | especially if you're putting a lot of pressure

01:58:48.220 | on the perineum.

01:58:49.680 | Your core is kind of like a box

01:58:52.520 | where your diaphragm sort of makes the top,

01:58:55.000 | and your abs and serratus make the front and the sides.

01:58:58.560 | Your back muscles make the back,

01:59:00.280 | and then your pelvic floor makes the bottom of the box,

01:59:03.480 | which is arguably the most important part of your core,

01:59:06.920 | and that pressure can weaken and even lead

01:59:09.400 | to incontinence and impotence.

01:59:13.240 | - So we were talking earlier today in the gym

01:59:15.680 | about how heavy legwork, hack squats, deadlifts,

01:59:19.480 | those kinds of things a lot of guys are doing

01:59:21.200 | to increase their testosterone done correctly

01:59:24.240 | can actually augment and build up the strength

01:59:26.520 | of the pelvic floor.

01:59:27.760 | Done incorrectly can actually weaken the pelvic floor

01:59:30.040 | and lead to all sorts of issues,

01:59:31.240 | including sexual effects, negative sexual effects.

01:59:34.040 | So how does one go about learning

01:59:37.240 | whether or not their movements are being done properly

01:59:39.560 | to support pelvic floor or to destruct pelvic floor?

01:59:43.540 | - The pelvic floor is a constellation of muscles,

01:59:47.680 | just like any other kind of like system in the body,

01:59:50.540 | and form is important if you're doing the Valsalva maneuver,

01:59:55.540 | which again is that kind of like bearing down

02:00:00.960 | or deep breath where you feel all of your abs are tight.

02:00:03.660 | You can also notice that your pelvic floor is tight as well.

02:00:07.520 | If you have a history of an inguinal hernia,

02:00:10.280 | which is a hole kind of like connecting the abdominal cavity

02:00:14.060 | down through the pelvic floor,

02:00:15.480 | or even the scrotum in some cases,

02:00:16.960 | then that can be a sign that there is weakness in that area,

02:00:21.840 | and you might have to concentrate it on it most,

02:00:23.860 | or even have a physiotherapist or a physical therapist

02:00:27.220 | specifically target the pelvic floor.

02:00:29.920 | Many exercises in which you Valsalva

02:00:32.640 | or use your glutes or legs,

02:00:35.800 | you can learn to squeeze them

02:00:37.200 | and have that mind-muscle connection

02:00:39.500 | in order to help build up the pelvic floor.

02:00:41.580 | And there's other things.

02:00:42.780 | Many people are familiar with Kegels.

02:00:44.640 | That is just one of the many different exercises

02:00:47.400 | that can help your pelvic floor.

02:00:49.140 | - My understanding is that

02:00:50.080 | while strengthening the pelvic floor is good,

02:00:52.200 | excessive contraction of the pelvic floor

02:00:53.960 | can actually limit blood flow to the pelvic area,

02:00:56.240 | the penis and so forth.

02:00:57.320 | So this is, again, it's a double-edged sword, right?

02:00:59.880 | I mean, you don't want guys out there

02:01:01.600 | to just start doing endless number of Kegels every day

02:01:04.240 | because they're actually going to constrict blood flow

02:01:05.880 | to that area, right?

02:01:07.520 | And in fact, the erection response is parasympathetic.

02:01:11.320 | It's a relaxed, induced response, right?

02:01:14.080 | - Correct.

02:01:14.920 | - So, you know, for the reason I chuckle is that, you know,

02:01:18.480 | 'cause we're talking about things,

02:01:19.460 | we don't have visuals or charts,

02:01:20.800 | and certainly it's hard to know

02:01:23.480 | whether or not a given exercise like Kegels

02:01:25.840 | are going to be good or not good.

02:01:28.160 | If it's excessive, what, you know,

02:01:29.360 | how many sets and reps does it take

02:01:32.040 | before it goes from good to bad?

02:01:34.440 | Is there a kind of general rule of thumb

02:01:35.880 | for people to think about this?

02:01:37.000 | I mean, clearly blood flow to that area is key, right,

02:01:41.120 | for sexual performance.

02:01:42.160 | And yet when one trains the legs or even walks,

02:01:45.300 | you're getting blood flow.

02:01:47.000 | So my understanding is this,

02:01:48.440 | that a combination of weight training

02:01:50.960 | to stimulate the positive hormonal and muscular

02:01:53.420 | and connective tissue growth is key,

02:01:56.760 | provides not over-training,

02:01:58.040 | but so is casual exercise like walking and stretching

02:02:02.520 | and the sorts of things

02:02:03.360 | that will then return blood flow to that area.

02:02:05.400 | Is that an overly basic way to think about it

02:02:08.640 | or will that suffice?

02:02:09.900 | - I think that's a good way to think about it.

02:02:12.120 | I think the main point with Kegels

02:02:13.720 | is they're just a one of many different things.

02:02:17.000 | So if you're having some pelvic floor pathology, certainly,

02:02:20.200 | or even just concerned about your pelvic floor,

02:02:22.840 | don't just, you know, take the advice,

02:02:25.640 | do Kegels and you'll be okay.

02:02:27.200 | That is not near enough.

02:02:28.340 | It's just one of the many aspects.

02:02:30.520 | - Okay, so going back to the rapid Q and A,

02:02:33.520 | and then we'll come back to this issue of blood flow

02:02:35.200 | 'cause there's some interesting science

02:02:36.480 | and protocols there.

02:02:37.920 | Question I have is alcohol,

02:02:40.180 | does it increase aromatase,

02:02:42.460 | the enzyme that converts testosterone into estrogen or not?

02:02:45.360 | And is there a dose dependence there?

02:02:48.500 | - It significantly does.

02:02:49.940 | There is a dose dependence.

02:02:51.320 | In general, I would not recommend more than

02:02:55.260 | three to four, you know, standard drinks.

02:02:59.020 | One huge glass of wine is probably five standard drinks,

02:03:02.340 | but say every two weeks.

02:03:07.340 | - Yeah, that's consistent

02:03:08.280 | with what I discovered researching alcohol

02:03:10.780 | in an episode we did on alcohol,

02:03:12.640 | that no alcohol is definitely better

02:03:15.780 | for all aspects of health than any alcohol.

02:03:17.780 | And anyone that says that,

02:03:18.620 | well, red wine contains these various things.

02:03:20.640 | Well, it doesn't contain enough of those positive things

02:03:23.260 | to have a positive effect.

02:03:24.220 | But that if people do opt to drink alcohol,

02:03:27.240 | that two drinks per week,

02:03:29.340 | and meaning 20 grams of alcohol,

02:03:32.800 | so that's probably two 12 ounce beers

02:03:34.860 | or two, you know, four ounce glasses of wine

02:03:37.500 | is going to be the upper limit

02:03:38.940 | beyond which you're going to start seeing

02:03:40.260 | all sorts of negative effects.

02:03:42.060 | - The other thing to keep in mind with alcohol

02:03:43.620 | is it has a lot of calories, seven kilocalories per gram,

02:03:46.660 | almost as much as fat, which is nine.

02:03:49.300 | And then it's also very GABAergic.

02:03:51.200 | So it can activate inhibitory neurotransmission.

02:03:56.020 | And that can also affect how many,

02:03:59.620 | how much LH and FSH is released.

02:04:02.680 | So that can also decrease testosterone,

02:04:04.900 | almost kind of similar to how opiates

02:04:08.540 | can decrease testosterone.

02:04:10.620 | - I feel very lucky that I don't enjoy alcohol,

02:04:13.700 | never really did, can kind of take it or leave it.

02:04:16.500 | Certainly don't like sedatives like Valium

02:04:18.580 | or anything like that,

02:04:19.420 | which as you just mentioned, can suppress testosterone.

02:04:22.740 | You said the word fat.

02:04:24.060 | So I'm going to pick up on that and say,

02:04:27.220 | in order to optimize hormone production,

02:04:29.100 | is it important to have some saturated fat in one's diet?

02:04:33.360 | And what happens on very low fat diets

02:04:35.300 | to testosterone, estrogen, and other steroid hormones?

02:04:38.300 | - Fat's interesting because there are so many different

02:04:42.880 | beneficial fats, omega-3s,

02:04:45.240 | almost every American gets plenty of omega-6s

02:04:47.900 | in any developed country, really.

02:04:50.300 | When it comes to saturated fat,

02:04:52.960 | there is more of a correlation with hormone optimization.

02:04:56.480 | If you're eating things with saturated fat,

02:04:58.860 | you tend to have, those are things with more,

02:05:01.660 | fat soluble vitamins and things that are very nutrient dense

02:05:05.280 | otherwise, but it is not vital.

02:05:07.740 | In general, you want to eliminate any trans fat,

02:05:10.980 | unless it's trans fat from the ruminants.

02:05:13.200 | There's always an exception to everything, right?

02:05:15.040 | So there is healthy trans omega-3 fats,

02:05:17.740 | which are formed in the stomach of like grass-fed

02:05:20.140 | and finished ruminants.

02:05:22.480 | - But ingesting mostly olive oils,

02:05:26.400 | maybe nut butters in limited amounts

02:05:29.340 | 'cause they're very calorie dense,

02:05:30.920 | but unless people are trying to increase their calories,

02:05:33.320 | in which case they're a great source of calories.

02:05:35.620 | Small amounts of butter, ghee, probably okay,

02:05:39.060 | but not excessive amounts.

02:05:40.060 | Is that the idea? - Correct, yes.

02:05:41.860 | Fat is perfectly fine.

02:05:43.540 | Cholesterol has an interesting,

02:05:45.940 | so cholesterol and in general phospholipids

02:05:48.960 | make the bilayer that's around the cell,

02:05:51.540 | but cholesterol is also a hormone in and of itself

02:05:54.620 | because it binds to the estrogen-related receptor alpha.

02:05:58.720 | So I consider that like in the estrogen receptor category

02:06:01.820 | and that can help with metabolism,

02:06:03.420 | but also potentially have concerns for cancer

02:06:06.980 | and tumor risk.

02:06:08.780 | - I want to go back to the prostate

02:06:10.700 | and talk to you about something

02:06:11.900 | that's kind of a newer emerging trend.

02:06:14.180 | I know that you've talked to a little bit about this

02:06:16.440 | in a previous podcast, that a number of men,

02:06:19.980 | or I should say a number of physicians

02:06:21.460 | are prescribing low-dose tadalafil,

02:06:25.020 | also known as Cialis, to their male patients.

02:06:28.060 | So in dosage ranges of like 2.5 milligrams

02:06:30.680 | to five milligrams per day,

02:06:31.980 | but not for erectile dysfunction,

02:06:33.580 | but rather for improving prostate health.

02:06:36.160 | And presumably they get sort of a boost

02:06:37.940 | in terms of blood flow to the genitalia as well.

02:06:41.100 | But again, not specifically to deal with erectile dysfunction

02:06:45.000 | but to deal with prostate health

02:06:47.140 | and blood flow to the prostate.

02:06:49.100 | Is that something that you sometimes often prescribe

02:06:51.700 | to your patients and of what age?

02:06:53.720 | - Tadalafil is a very underrated medication.

02:06:57.580 | The age would kind of depend on the indication.

02:07:01.060 | So tadalafil is also a blood pressure medication.

02:07:04.500 | It can very slightly decrease blood pressure,

02:07:06.360 | especially at higher doses.

02:07:08.540 | At higher doses, a high dose would be 20 milligrams,

02:07:12.500 | not 2.5 milligrams.

02:07:14.520 | But consistently, it can somewhat affect

02:07:17.040 | with the cones in the eye

02:07:18.720 | that have to do with red and green site.

02:07:20.700 | Although if you remove it, that effect is reversed.

02:07:23.140 | So basically, if you don't need really, really good

02:07:25.620 | red-green discrimination, you can take higher doses.

02:07:28.300 | But in general, I recommend no higher

02:07:30.220 | than 10 milligrams a day,

02:07:31.660 | usually just two or five milligrams.

02:07:35.600 | One other benefit or other use of tadalafil

02:07:39.500 | is that it increases the density of the androgen receptor,

02:07:42.740 | similarly to L-carnitine.

02:07:44.540 | So that's an interesting benefit.

02:07:47.040 | Another benefit is that if you give it to people

02:07:49.740 | with nocturia, which is urinating at night in general,

02:07:52.780 | it will cut the episodes in half.

02:07:54.700 | So it could go from two to one,

02:07:57.000 | which can make a big difference for your sleep,

02:07:59.000 | which will secondarily make a big difference

02:08:00.820 | for your growth hormone and testosterone optimization.

02:08:03.180 | - Interesting, so you said 2.5 to five milligrams per day

02:08:06.260 | is kind of typical for these prostate-enhancing effects.

02:08:09.180 | - Yes.

02:08:10.260 | - And you mentioned the potential side effects

02:08:12.660 | on adjusting visual perception.

02:08:14.240 | As a vision scientist, that rings in my mind.

02:08:17.840 | But in terms of red-green color discrimination,

02:08:20.560 | I'm guessing, unless you're going to be a subject

02:08:22.340 | in one of the experiments in my lab,

02:08:24.120 | where you want to be a fighter pilot,

02:08:25.780 | chances are you can probably get away

02:08:27.080 | with a little less red-green color discrimination.

02:08:29.520 | - Correct, it's not considered clinically significant

02:08:32.020 | unless someone is a commercial pilot.

02:08:35.240 | - Great.

02:08:36.080 | - So if someone's getting their pilot exam,

02:08:37.800 | that's one of the things we look for.

02:08:39.440 | - Okay, so commercial pilots aside,

02:08:41.220 | you might want to ask your doctor about low dose to dalafil

02:08:44.120 | for sake of enhancing prostate health.

02:08:46.740 | Certainly monitoring PSA, prostate-specific antigen,

02:08:49.400 | is important.

02:08:50.240 | I can give an anecdote there.

02:08:52.260 | When I tried sermorelin, one of the surprising side effects

02:08:55.780 | that was not welcome was a dramatic spike

02:08:59.180 | in my prostate-specific antigen.

02:09:00.700 | No one could explain to me why that would happen,

02:09:04.460 | but when I stopped taking sermorelin,

02:09:05.980 | it went back to normal.

02:09:07.040 | So that's one reason I avoid sermorelin,

02:09:09.360 | at least frequent use of sermorelin.

02:09:11.740 | PSA should be kept, what, below levels of,

02:09:14.780 | somewhere between one and four is considered healthy.

02:09:17.160 | Is that right?

02:09:18.100 | - It depends on the age.

02:09:19.300 | If there's a 20-year-old, likely between zero and one.

02:09:22.320 | If there's a 40-year-old, likely between one and three.

02:09:26.880 | And then if there's an 80-year-old,

02:09:28.320 | it would not be abnormal to have a PSA of five

02:09:31.260 | and have that be well within the reference range.

02:09:34.160 | Another thing we should mention about PSAs,

02:09:35.960 | if you do take a 5-alpha reductase inhibitor,

02:09:38.720 | like finasteride or dutasteride,

02:09:41.340 | often these will cut your PSA in half.

02:09:44.240 | So if you, for example, if you have a PSA of six

02:09:47.840 | and you start finasteride or dutasteride,

02:09:49.980 | and then you recheck it in six months and it's 6.5,

02:09:53.200 | that is a huge concern because that's actually doubled.

02:09:56.060 | - I'm glad you brought this up

02:09:57.960 | because I almost overlooked the fact that

02:10:00.560 | I get a lot of questions about drugs to offset hair loss.

02:10:04.960 | Most of those drugs are going to operate

02:10:06.880 | through the DHT system, the dihydrotestosterone system,

02:10:09.380 | for the reasons we talked about before,

02:10:10.580 | DHT receptors being on the scalp

02:10:12.200 | and causing beard growth on the face.

02:10:15.600 | Is it the case that a number of people taking

02:10:18.800 | things like Propecia and other things to block the DHT

02:10:22.700 | or disrupt the DHT pathway

02:10:24.800 | are going to experience diminished sex drive,

02:10:28.160 | diminished kind of motivation and general vigor?

02:10:32.400 | And if so, are there alternatives

02:10:34.080 | like topical DHT antagonists that they might use

02:10:37.240 | if they want to keep their hair

02:10:39.600 | but not have those negative effects?

02:10:41.400 | - The way that I think about hair loss

02:10:44.680 | is you have your fertilizers,

02:10:47.400 | also known as growth agonists,

02:10:48.840 | and then you have your anti-androgens.

02:10:51.260 | Whether they're systemic or topical, there's both,

02:10:54.440 | but that's the general layman's way to think about hair loss.

02:10:57.660 | If you're only putting fertilizer in your hair

02:10:59.580 | but you have androgenic alopecia or male pattern baldness,

02:11:02.640 | then those hairs will still miniaturize

02:11:04.380 | and eventually you'll still have loss.

02:11:05.960 | - Such a great word, miniaturize.

02:11:08.000 | - Yeah. - Yeah.

02:11:08.840 | It's enough to send anybody off to find a therapeutic, right?

02:11:11.520 | - And by the way, it's difficult to tell

02:11:12.880 | if miniaturization's happening unless you have

02:11:14.600 | a magnifying glass.

02:11:15.720 | You can use a shot. - I almost shouldn't know.

02:11:18.000 | For a second there, I didn't know whether or not

02:11:19.080 | you were making a joke.

02:11:19.960 | You're talking about miniaturization of the hair follicle.

02:11:22.120 | - Correct, yeah.

02:11:22.940 | - So what can reverse that miniaturization?

02:11:24.840 | That's just a fun word to say.

02:11:25.980 | I'm going to just keep saying it.

02:11:27.120 | - Each individual has, again,

02:11:29.460 | we mentioned the androgen receptor.

02:11:31.300 | Males only have one androgen receptor genus

02:11:33.880 | on their X chromosome.

02:11:35.440 | So depending on how sensitive that androgen receptor is

02:11:38.440 | and depending on the density of the receptors

02:11:41.920 | in the hair follicle,

02:11:43.500 | you can have a arbitrary threshold

02:11:47.040 | and you don't know what this threshold is

02:11:49.040 | until you start to have miniaturization and loss of hair.

02:11:52.320 | But over the threshold, the follicle will die

02:11:55.520 | and eventually the stem cell will leave.

02:11:57.440 | But under the threshold, you're okay.

02:12:00.720 | Every androgen binds to the same androgen receptor.

02:12:03.840 | So there is nothing special about DHT.

02:12:06.680 | DHT is just a stronger androgen.

02:12:09.280 | So the higher your SHBG, things that increase SHBG

02:12:13.640 | are beneficial for hair loss prevention

02:12:16.380 | because you have less binding of that receptor.

02:12:19.060 | So if you think about hair loss,

02:12:20.520 | specifically androgenic or male pattern baldness

02:12:23.160 | in the terms of that androgen receptor

02:12:26.160 | and everything in general binding to it,

02:12:28.440 | not just DHT, but also testosterone, it's helpful.

02:12:31.520 | It's just that DHT is a huge battering ram,

02:12:34.360 | whereas the other androgens

02:12:35.600 | are just light presses on the door.

02:12:37.440 | - Got it, so are some of the topical DHT receptor

02:12:41.200 | antagonists going to be a better choice

02:12:43.560 | for people that want to maintain or their hair

02:12:46.080 | or grow more hair if they want to avoid side effects?

02:12:50.140 | - Likely so.

02:12:51.580 | Some individuals benefit from systemic,

02:12:55.760 | a systemic decrease in DHT for a couple of reasons.

02:12:58.840 | One could be prostate and then one could actually be

02:13:01.840 | hypertrophy of the myocardium.

02:13:04.160 | So DHT also disproportionately thickens the ventricle.

02:13:08.120 | So for someone on TRT, that might be a benefit

02:13:10.320 | that is prone to thickening of the ventricle at baseline.

02:13:14.120 | However, many people that have just a bit of predisposition,

02:13:18.440 | they can use things that are topical anti-androgens.

02:13:22.760 | Ketoconazole is one of them.

02:13:24.240 | Caffeine is actually another one.

02:13:26.000 | - Wait, drinking caffeine?

02:13:27.480 | - Topical caffeine.

02:13:28.360 | - Oh, I was going to say, my hair tends to grow pretty fast,

02:13:31.200 | but I drink a lot of caffeine.

02:13:32.240 | - So topical caffeine, really rubbing coffee on their head

02:13:35.200 | or taking caffeine tablets and how does it,

02:13:38.600 | wait, you have to explain how this works.

02:13:40.740 | How do people get caffeine into the hair follicle?

02:13:43.380 | - Topically, the caffeine enters the scalp and crowds out,

02:13:48.600 | like somewhat crowds out the androgen.

02:13:50.480 | It is a weak effect.

02:13:52.700 | It's likely just strong enough

02:13:54.800 | to be clinically significant.

02:13:56.120 | Usually caffeine is put into formulations

02:13:58.480 | with other things like ketoconazole

02:14:00.760 | that are also weak anti-androgens.

02:14:03.600 | Of note, spironolactone can be prescribed topically,

02:14:06.560 | but it is absorbed systemically

02:14:08.680 | because of the size of the molecule.

02:14:10.520 | So unless your doctor specifically prescribes that for you,

02:14:13.580 | especially as a male, do not use topical spironolactone.

02:14:17.320 | Topical finasteride is also a smaller molecule.

02:14:21.180 | So it is also systemically absorbed,

02:14:23.520 | but it is not extremely well systemically absorbed.

02:14:26.760 | If you take topical finasteride,

02:14:28.900 | and usually your systemic DHT will decrease by about 30%.

02:14:33.460 | Topical dutasteride is likely a tiny bit

02:14:36.960 | systemically absorbed, but it's unique

02:14:38.560 | because it's half life is much faster at a lower dose.

02:14:41.960 | So topical dutasteride will not affect

02:14:44.740 | your systemic DHT at all.

02:14:46.380 | And I've seen this anecdotally on many people

02:14:48.540 | on topical dutasteride therapy.

02:14:50.840 | - We're going to have to get you back on here

02:14:52.120 | and do an episode all about DHT and hair loss

02:14:54.560 | and hair growth is, you know, again,

02:14:56.380 | not a topic that I focus on a lot for myself,

02:14:59.540 | but that I get a lot of questions about for men and women.

02:15:02.860 | - One thing that we could mention,

02:15:04.440 | I got a ton of questions about turmeric

02:15:06.600 | and curcuminoids after last episode.

02:15:09.140 | - Oh yeah, but I had reported my own anecdotal experience

02:15:12.440 | that taking turmeric really crushed my DHT levels

02:15:15.440 | and I did not feel good.

02:15:16.760 | I mean, it crushed all sorts of positive feelings of vitality

02:15:21.080 | the moment I stopped taking turmeric, felt great again.

02:15:24.120 | Many people report this and the interesting thing

02:15:27.560 | about turmeric is most of it's beneficial action,

02:15:30.760 | not all of it.

02:15:31.600 | Some people benefit from systemic turmeric

02:15:34.320 | and some people that can tolerate it well,

02:15:35.820 | it's actually great for the prostate,

02:15:38.200 | but most of the action, it does not need to be bioavailable.

02:15:41.680 | It acts on the gut microbiome.

02:15:43.520 | So you can take turmeric and if it is not absorbed,

02:15:48.000 | some turmeric is put in special formulations

02:15:50.240 | like micellar or liposomal or complexed,

02:15:53.640 | but a lot of it is put with black pepper fruit extract,

02:15:56.280 | which is also known as biopurine,

02:15:58.000 | which is actually also a 5-alpha reductase inhibitor

02:16:01.220 | and it affects liver cytochromes.

02:16:03.560 | And so many supplement companies

02:16:04.960 | put this black pepper fruit extract,

02:16:06.960 | biopurine in almost everything.

02:16:09.280 | So some people are on really high doses

02:16:11.520 | and that could also be making most of the effect of people

02:16:15.700 | who do not tolerate turmeric well.

02:16:17.400 | - Yeah, I avoid turmeric like the plague

02:16:19.920 | based on that one previous experience

02:16:21.640 | 'cause it was clearly turmeric

02:16:24.480 | that caused the negative effect coming off it,

02:16:27.300 | everything reversed rapidly.

02:16:29.160 | And the biopurine, the black pepper extract,

02:16:31.760 | I also avoid that like the plague

02:16:33.180 | based on everything you just said.

02:16:35.080 | I want my 5-alpha reductase, I want my DHT to be optimized

02:16:40.080 | simply because my understanding is DHT

02:16:42.680 | is the more powerful androgen and it's the one that,

02:16:46.800 | yes, it causes a little bit of hair loss

02:16:48.280 | and I've got a few patches here and there,

02:16:50.200 | but I'm willing to live with that

02:16:52.120 | based on all the other wonderful things

02:16:53.480 | that DHT optimization does.

02:16:56.400 | - I'll quickly mention a few other things.

02:16:58.320 | One, solpalmetto is also a 5-alpha reductase inhibitor,

02:17:02.200 | but only a couple of the isoenzymes.

02:17:04.700 | There's three main isoenzymes and a lot of the problem

02:17:08.020 | is that you're inhibiting a couple of the isoenzymes,

02:17:11.300 | but not the other one.

02:17:12.920 | Finasteride inhibits one and two.

02:17:16.640 | Dutasteride actually inhibits all three.

02:17:19.240 | And finasteride inhibits the isoenzyme

02:17:22.800 | that is in genital skin, but not in the skin

02:17:25.760 | throughout the rest of your body.

02:17:27.480 | So a lot of the side effects of finasteride,

02:17:29.760 | which is loss of sensation and loss of erectile function

02:17:33.720 | have to do with the disconcordance

02:17:37.560 | between the sensitivity of the genital skin and the skin.

02:17:41.120 | - Again, another reason to not disrupt 5-alpha reductase.

02:17:44.600 | And we'll definitely get you back on here to talk about,

02:17:47.000 | I think we should just do a whole episode about DHT

02:17:49.080 | because so often when people are thinking

02:17:50.520 | about optimizing hormones,

02:17:51.960 | especially males trying to optimize their hormones,

02:17:55.360 | they're thinking testosterone, testosterone.

02:17:56.920 | Maybe nowadays they think a little bit more

02:17:58.340 | about free testosterone and maybe they think about estrogen

02:18:00.980 | as also being important, not to crush estrogen,

02:18:02.900 | but DHT is, you know, at least to my mind,

02:18:06.120 | the linchpin of so many of the things that subjectively

02:18:08.760 | people are really focused on libido,

02:18:10.600 | motivation, drive, et cetera.

02:18:13.120 | I have one final question.

02:18:14.100 | It's just a brief one,

02:18:14.940 | but many of us have heard that the BPAs

02:18:17.440 | that are present in, you know, plastic bottles

02:18:19.500 | and even in certain aluminum cans and phthalates,

02:18:22.720 | a difficult word to pronounce, but a fun one nonetheless,

02:18:25.520 | phthalates and work by Dr. Shana Swan has shown

02:18:29.160 | that phthalate exposure to the fetus,

02:18:32.120 | to pregnant mothers and to fetuses,

02:18:34.000 | very likely is negatively impacting sperm counts,

02:18:36.640 | testosterone levels, and even changing genitalia size

02:18:39.860 | for the worse in males nowadays.

02:18:43.060 | I saw a beautiful lecture that Dr. Shana Swan did

02:18:47.040 | on this when I was in Copenhagen,

02:18:48.540 | and it's very clear that it's negatively impacting

02:18:50.720 | the male fetus.

02:18:51.560 | She was also on Joe Rogan's podcast.

02:18:53.000 | I hope to get her on this podcast.

02:18:54.900 | However, what she couldn't answer for me

02:18:57.680 | was whether or not phthalates and BPAs

02:18:59.840 | and these things present in plastics,

02:19:01.240 | and some people even claim in tap water,

02:19:03.520 | are bad for males after they're born and after puberty.

02:19:08.420 | What are your thoughts on, or I should just ask you,

02:19:11.000 | do you drink water out of plastic bottles?

02:19:13.040 | Do you avoid drinking out of cans that are not specifically

02:19:17.600 | non-BPA containing cans?

02:19:20.080 | And do you actively avoid phthalates?

02:19:21.960 | My understanding is that phthalates are most enriched

02:19:23.900 | in pesticides, and that's why you're seeing dramatic drops

02:19:26.840 | in sperm and testosterone levels,

02:19:28.880 | mainly in rural areas where they're dust cropping.

02:19:32.120 | - Yeah, so I do avoid drinking out of cans that,

02:19:35.040 | or plastics that may have BPA or bisphenol A in them.

02:19:40.360 | Bisphenol A is known to bind to what I would consider

02:19:44.400 | the fifth estrogen receptor, estrogen-related receptor gamma.

02:19:48.460 | So I would consider it a xenoestrogen.

02:19:52.840 | So phytoestrogens are estrogens from plants,

02:19:55.160 | and in general, they're not concerning

02:19:56.480 | or clinically significant,

02:19:57.620 | and xenoestrogens are just other estrogens.

02:20:01.000 | So I do avoid BPA, and I also test my water.

02:20:05.680 | I use a water testing service,

02:20:07.520 | and I test it both after it's through my water filter

02:20:11.400 | and the tap water that my two boys drink almost every day.

02:20:16.120 | And it was very interesting.

02:20:17.120 | I only found one microplastic just a bit

02:20:19.720 | over the reference range.

02:20:21.760 | So it wasn't a terrible tap score,

02:20:23.500 | but even in developed countries, these are widely variable.

02:20:27.300 | As far as phthalates, again, very difficult

02:20:31.640 | and interesting to pronounce,

02:20:33.680 | but I remember learning about these because there was,

02:20:36.240 | I believe, a lawsuit that had to do with mac and cheese.

02:20:40.520 | And this was probably five years ago,

02:20:44.040 | and I was coming up with my list of,

02:20:47.200 | each provider that does obstetrics has a list

02:20:49.640 | what to avoid for the pregnant lady.

02:20:51.200 | You know, sketchy deli meats or high mercury fish

02:20:55.360 | like swordfish and salmon,

02:20:56.480 | and I actually added processed mac and cheese to that list.

02:21:00.160 | - Interesting.

02:21:01.200 | Well, thank you for that.

02:21:02.040 | I'm going to extract your statement

02:21:03.920 | that you avoid drinking out of plastic bottles when possible.

02:21:07.440 | I'm guessing you're not neurotically attached to that.

02:21:09.200 | If you were dying of thirst,

02:21:10.200 | you might crack a plastic bottle of water to survive.

02:21:12.800 | But listen, Kyle, Dr. Gillette, thank you so much.

02:21:17.800 | You gave us an enormous wealth of knowledge,

02:21:21.040 | everything from behaviors to psychology

02:21:24.760 | to supplementation to prescription drugs.

02:21:27.880 | We will make sure to point out

02:21:29.520 | where people can get ahold of you on Instagram

02:21:31.520 | and on Twitter and on other websites

02:21:35.420 | in our show note captions.

02:21:36.680 | But really just on behalf of the audience

02:21:39.160 | and just for myself, thank you so much.

02:21:41.460 | You have an immense amount of knowledge

02:21:42.920 | and you're exquisitely good at sharing it with people

02:21:45.780 | in an actionable way.

02:21:46.620 | So thank you.

02:21:47.800 | - My pleasure.

02:21:49.100 | - Thank you for joining me today

02:21:50.240 | for my discussion with Dr. Kyle Gillette,

02:21:52.000 | all about male hormone optimization.

02:21:54.640 | And I just want to remind everybody

02:21:56.120 | that we will soon have an episode

02:21:57.500 | all about female hormone optimization.

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02:22:55.660 | While supplements aren't necessary for everybody,

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02:24:03.920 | Thank you once again for joining me for today's discussion

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02:24:12.560 | [upbeat music]

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Dr. Kyle Gillett: Tools for Hormone Optimization in Males | Huberman Lab Podcast 102

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